At a meta level, does minority even truly mean “minority” anymore? If I said “minorities” referring to people in California people would assume I’m referring to Latinos and not White people even though there are more Latinos than White people.
It really is just important to discuss the context. Usually, if a disadvantage is discussed in relation to a "minority", it generally has less to do with the real world diaspora they belong to and more the fact that they are in the minority.
For instance, the fact that "minorities" are more susceptible to COVID in the first place (in the US, at least) isn't because of racial makeup or ancestral heritage, but rather because marginalized people in the US are more likely to be in "front line" jobs that come in contact with large groups of people (service workers, hospital janitorial staff, food workers, the like) and much less likely to be in a position to remove themselves or work from home.
In this context, the context is the US, not California. Latinos are a minority in the US, regardless of what they are in California or the world.
We're trying to talk about the vaccine's effectiveness. We're trying to talk about biology, and it's kind of urgent at the moment. Can we please give sociology issues a pass for a bit?
It's a fact that there's a genetic component in susceptibility to different diseases. One example: the 1918 Spanish Flu killed > 5 % of people on the Indian Subcontinent, but in China it was hardly noticeable in the death figures. Instead of pussyfooting around the issue of Race in America (it is an issue, mind), one should say that in population X the vaccine may be less efficaceous.
EDIT: apologies HarryHirsch, it was relevant if I just read until the end. You did explain a better way to phrase it. I think you're right that using the word "population" is better here. Good reminder to me to make sure I understand what someone is saying before rejecting them.
> the team found that the number of people whose immune system didn’t robustly respond to the vaccine ranged from less than half of one percent of white participants to nearly 10 percent of Asian participants. ... our preliminary results suggest that, on average, people of Black or Asian ancestry could have a slightly increased risk of vaccine ineffectiveness
It would be more accurate to say that a person's race may have an effect on the effectiveness of a vaccine but it's still relevant to class them as minorities in the places where the effectiveness is being studied. If a vaccine is being studied in a population of 40000 and only 100 of those people are black, you won't be able to learn as much about the vaccine's effects on people of a certain race because of the low sample size. It's of course relevant for those in countries where those races are majority and more studies need to be done in those places as well.
There are some absolutely brilliant scientists in China working on vaccine development right now! Let's stop hand-wringing, this is a global public health issue, not a political issue, and China is working on it too.
"If China’s COVID-19 vaccines work, manufacturers say they could turn out 1.5 billion doses in total next year. And countries that cannot access vaccines bankrolled by Warp Speed—especially those that hosted China’s efficacy trials—might have a more secure vaccine supply."
"Yanzhong Huang, a global health specialist at both Seton Hall University and the Council on Foreign Relations, says the country is “actually using the vaccine to promote the diplomacy of foreign policy objectives.” This “vaccine diplomacy” he says, contrasts starkly with Warp Speed’s “vaccine nationalism” and aims to “fill in the void left by the United States.”
“It is a very carefully executed and carefully thought out strategy,” says Stephen Morrison, who directs the Global Health Policy Center at the Center for Strategic & International Studies. “A strategic goal of the Chinese government is to achieve hegemonic influence in the bioeconomy within the next decade.”
"At home, too, attitudes toward vaccines contrast with those in the United States and Europe, where mistrust is high, Morrison says. To the consternation of vaccine experts overseas, hundreds of thousands of people in China have already lined up to receive the experimental vaccines—even before their value and safety have been proved. “There has not been a collapse of faith and trust in science and in the state,” Morrison says. “There’s less fear about where this is all going.”
I'm not a huge fan of a lot of what the Chinese government does, but the U.S. is in the throes of some seriously crazy shit right now, and could take a lesson.
> Gifford and PhD students Ge Liu and Brandon Carter also presented a promising new ML-based approach for improving the vaccines’ effectiveness with certain populations: adding a small number of additional Covid-19 peptides to a given dose of the vaccine.
> The team’s “augmentation” vaccines use vaccine components that have been observed to cause immune system responses in COVID-19 patients. As shown in the below chart, by adding somewhere between 5 and 50 additional peptides to a particular dose, the team says that preliminary tests show that they improved the vaccine’s effectiveness to nearly 100 percent in all populations.
Is adding peptides to a vaccine something that has been done before, or is this new? And how do you add peptides to a vaccine?
> some health experts have expressed caution about the companies’ confident assertions that the vaccines are 95 percent effective for all populations.
Obviously a vaccine isn't going to erase preexisting differences in health outcomes. Closer to a factor on some prior susceptibility (though of course not so cleanly linear in reality).
Moderna has a statement that, "Efficacy was consistent across age, race and ethnicity, and gender demographics. The 196 COVID-19 cases included 33 older adults (ages 65+) and 42 participants identifying as being from diverse communities (including 29 Hispanic or LatinX, 6 Black or African Americans, 4 Asian Americans and 3 multiracial participants)." https://investors.modernatx.com/news-releases/news-release-d...
The article makes it sound like they're not basing their finding on the actual vaccine trial data, so is this hyperbole?
The public wants something impossible, there are no time machines or time compressors, there are no regulatory changes to make, you can't get the same results as past vaccine trials from this vaccine's trials conducted with many fewer people and far less time.
So for Asian Americans, Moderna's findings are equivalent to flipping four (4) coins, and declaring from the results (which we don't see here) that coins come down as Heads 94% of the time.
Folx, there is a minority within a minority here. The Latinx minority[0]. We need to ensure that the vaccine works as effectively for Hispanic people as it does for Latinx people.
If I'm reading this correctly this is not based on actual experimental evidence. There's some reason to think that Caucasians have more active innate immune system during to selective pressure from plague, but not much.
I did a quick back of the envelope calculation of what MIT means by "racial minorities" in the context of this global pandemic. They mean more than 85% of the population of the planet.
I assume they mean minorities with respect to the country where the vaccine was developed.
However the main purpose of a vaccine is herd immunity.
If a large enough majority of the population become immune that we achieve herd immunity, that will still protect the minority of people for whom the vaccine didn't work.
> However the main purpose of a vaccine is herd immunity.
This is false when it comes to the COVID-19 vaccines under development. They do not—and are not meant to—prevent people from contracting and spreading the virus. They only reduce the symptoms. This does not help herd immunity (other than perhaps allowing the virus to spread faster, I guess).
Unless you're a PhD molecular biologist (I'm not) with some meta-understanding of mRNA vaccines and I've missed something, I think the person you're responding to is actually correct.
"COVID-19 mRNA vaccines are given in the upper arm muscle. Once the instructions (mRNA) are inside the muscle cells, the cells use them to make the protein piece. After the protein piece is made, the cell breaks down the instructions and gets rid of them."
"Next, the cell displays the protein piece on its surface. Our immune systems recognize that the protein doesn’t belong there and begin building an immune response and making antibodies, like what happens in natural infection against COVID-19."
"At the end of the process, our bodies have learned how to protect against future infection. The benefit of mRNA vaccines, like all vaccines, is those vaccinated gain this protection without ever having to risk the serious consequences of getting sick with COVID-19."
The quote you use doesn't claim sterilizing immunity but the "protection" and is misleading. The publicly reported protection of the vaccines seeking EUA is against the symptomatic disease, as it can be seen in the protocols of the vaccine studies.
"To be considered as a case of COVID-19 for the evaluation of the
Primary Efficacy Endpoint, the following criteria must be met:
- The participant must have experienced at least TWO of the
following systemic symptoms: Fever (≥ 38ºC), chills,
myalgia, headache, sore throat, new olfactory and taste
disorder(s), OR
- The participant must have experienced at least ONE of the
following respiratory signs/symptoms: cough, shortness of
breath or difficulty breathing, OR clinical or radiographical
evidence of pneumonia; AND
- The participant must have at least one NP swab, nasal swab,
or saliva sample (or respiratory sample, if hospitalized)
positive for SARS-CoV-2 by RT-PCR."
In some other protocols it's not written in an easily quotable way but spread through the text and tables, but if you analyze the protocols carefully, the goal is the same: it's the vaccinated and symptomatic that are counted and compared with the symptomatic counted in the placebo group.
So whenever you saw "protection" up to now it was implicit it's the protection from the disease as defined above. Not the sterilizing immunity.
Moderna's announcement is also explicit in mentioning so defined "primary endpoint":
"The primary endpoint of the Phase 3 COVE study is based on the analysis of COVID-19 cases confirmed and adjudicated starting two weeks following the second dose of vaccine."
We should eventually know more, but we still don't have that information.
> That's a direct mechanism of protection that will help to both prevent people from getting sick
That's what the reported numbers claim: up to 95% people less are getting sick.
But it's unknown how much it will "knock down shedding" and the experts who follow only publicly available data are still cautious to claim the opposite of what you claim, specifically:
"it will be important to communicate to policy makers and the general public that first-generation vaccines are only one tool in the overall public health response to COVID-19 and unlikely to be the ultimate solution that many expect."
You may not like that or believe something else, but it's not what I hear and read the mentioned experts say, like, as an example, Natalie E. Dean whose article I've already linked to, and you can follow her other writings too. And, as far as I know, her opinion is far from being untypical, i.e. it would be easy to find more actual experts (which I define as those who were doing active research even before Covid-19 in the field and not something totally unrelated and who aren't just jumping in for political purposes -- note that that definition automatically excludes those like Ioannidis) who publicly say the same.
There is no ultimate public health solution ever in any situation!
Of course our response will be a multi-faceted approach! Look at how many businesses are now installing UV-lights in ventilation systems, allowing people to work from home, and how the wearing of masks has become normalized and accepted in many parts of the country!
People will no longer hesitate to throw on a mask if they feel ill, unlike before when we used to wander into Target sneezing and coughing all over everything! Think of how awesome that is for immunocompromised people!
The vaccine will be a critical link in a long chain that will hopefully save thousands, and thousands of lives. Whether it 100% eliminates the shedding of any measurable viral particles, knocks it down by 10%, 20%, 30%, 50% or whatever, it's a huge win. Right now we have zero way to even think about reducing viral shedding in real-world populations. We're relying 100% on social distancing and masks.
I’m not against the vaccine. I’m merely against your claims which weren’t true, specifically, your false claims about the known level of the immunity they provide, believing which could put people in danger.
“Exclusive: Coronavirus vaccine won't free you from self-isolation, says Government —- The jabs provide Covid-19 immunity but scientists are yet to prove this prevents recipients from carrying and spreading the virus”
“People who receive the coronavirus vaccine will not be exempted from self-isolation if they are contacted by NHS Test and Trace, it has emerged.
Although the vaccine will give recipients immunity from the virus, scientists do not yet know whether it will stop them being carriers.
Government sources said it was likely to be months before there was any prospect of the vaccine negating the need for self-isolation.
It means that even if someone has been vaccinated, they will still have to remain at home for 14 days if they come into contact with someone who has the virus.”
..
“Any other vaccine that might be approved by regulators, such as the one being developed by Oxford University, will also be subject to the same lengthy process of discovering whether it prevents people being “silent” carriers of the virus.”
The information you so generously "shared" was not helpful. You intentionally spread it in a misleading way, and at this point enough counter-evidence has been provided to you that you must know you were wrong, which means you are now arguing in bad faith. Nowhere on that page does the CDC claim that current COVID-19 vaccines prevent the spread of the virus (in fact they explicitly disclaim the vaccine's effect on herd immunity), but you selectively quoted to make it seem as though they might have said that.
To be fair, a large portion of the blame lies with whoever wrote the copy for that CDC marketing page, as they are intentionally obscuring the fact that these vaccines do not prevent the spread of the virus. It's easily understandable why they are obscuring that fact and I suppose we should just be thankful that they haven't spread any outright lies on that page, again by explicitly making no claims about herd immunity. Note that the page does explain to people that they need to keep social distancing after receiving the vaccine, which shows that the CDC does acknowledge privately that the vaccine does not prevent transmission of the virus.
I haven't actually seen any convincing counter-evidence presented in a clear and concise manner. I've seen some stuff that gets off in the weeds, but ignores the mechanism of T-cell and B-cell mediated immunity and the most plausible mechanisms of transmission at an aggregate level, and that only focuses on primary outcomes of clinical trials, while ignoring secondary outcomes.
But I haven't seen anything that was written in a way that would convince a mildly skeptical human (and I've spent some time behind a micropipette) that vaccines do nothing to prevent contracting and spreading viruses in a meaningful (clinical - not analytical) sense.
I'm coming to this with an open mind, and I don't think I'm being a jerk about anything. I shared a quote from the CDC at face-value. You're just some faceless dude on the internet. Why should I believe you over the CDC?
"At the end of the process, our bodies have learned how to protect against future infection." <-- This is straight-up saying that the vaccine protects you from getting infected. I'm not quoting out of context or anything. If enough people are protected against getting infected, we reach herd immunity. Am I missing something here?
I promise I'm not masterminding some elaborate FUD campaign to undermine your premise. You're just saying something that's super-counterintuitive and then getting angry at me because I don't see clear evidence for it in what you presented.
You have seen the scientists writing explicit contrary to your claims, and even the specific vaccine testing protocols, I’ve given you the exact links and quotes, but you doubled down. The UK authorized Pfizer/BioNTech vaccine, and still:
svrb's comment is specifically with regard to vaccines: "They do not—and are not meant to—prevent people from contracting and spreading the virus."
What you acqq are posting is “Although the vaccine will give recipients immunity from the virus, scientists do not yet know whether it will stop them being carriers."
Can you see the very fine semantic line that is being walked here?
The public is being told by health officials that the virus gives 'immunity' from the virus. In the same breath, you are supporting the argument that it does nothing to prevent people from contracting and spreading the virus.
You guys are acting like this is all rather obvious, but it's not at all.
If I walked up to someone on the street and said that a vaccine will give them immunity, what do you think they would take that to mean?
Well, the NHS, and the CDC are both saying that the vaccine gives 'immunity' and 'protection.'
You have to stop getting angry at me, and consider that if you're not making a convincing argument to me, how the hell are you going to make a convincing argument to somebody who doesn't have a degree in biochemistry.
“Pfizer chairman Albert Bourla told Dateline host Lester Holt that the pharmaceutical company was “not certain” if the vaccine prevented the coronavirus from being transmitted, saying, “This is something that needs to be examined.””
That's a pretty well-worded statement from Al. Sounds reasonable to me. There's no RCT to definitively prove beyond a shadow of a doubt that it will prevent someone who has received the vaccine from transmitting virus to another person under any circumstances, no matter how unusual.
Remember the claims at the start of this thread were:
"They [vaccines] do not—and are not meant to—prevent people from contracting and spreading the virus. They only reduce the symptoms."
Albert isn't saying any of that stuff, so why on earth would I disagree with him?
Article goes on to say "In November, Pfizer announced that its vaccine candidate had been shown to be more than 90 percent effective at preventing COVID-19"
Aaaaaand so we're back at my comment before this one. What do they mean by 'prevent?' Because they're saying it 'prevents' COVID-19, just like the CDC did in the quote I shared that svrb got so angry at me about.
You guys are saying the vaccine does nothing to prevent people from getting SARS-CoV-2, but the CDC, and the articles you yourself are sending me are saying that the damn thing 'prevents' COVID-19, which is an infection with SARS-CoV-2.
Is the vaccine magically making people asymptomatic while an infection rages inside of them? Is it preventing a virus that destroys lung tissue from somehow showing any outward signs of dyspnea? Is it somehow blocking a cytokine storm? I don't think so, that's how Dexamethosone is being used to treat this, not vaccines. Maybe in the long run by shifting Th1/Th2 response or something, but that would have quickly become apparent in the routine labs done in the process of clinical trials. Does it magically break up thromboemboli in the bloodstream? How would a vaccine prevent kidney damage from showing up in someone with a raging, yet completely asymptomatic infection?
What is the mechanism by which a vaccine would allow a raging infection to occur inside of someone, while showing zero outward signs of it? Because if it's knocking down levels of active virus in the body by triggering a robust T and B-cell response, it's reducing viral shedding, and it's reducing transmission. That's the same thing that all the papers you have shared with me so far have indicated.
What do you want me to say?
Don't sneeze on grandma until she gets vaccinated. I said that earlier.
No. Covid-19 is the illness (symptomatic). Exactly like defined in the vaccine protocols. One can carry a virus (one can have positive PCR) without being ill (asymptomatic). We also know that their CT value (which corresponds to the amount of virus) is often as low (low values are high amount of virus) as by those who have symptoms. That’s why they infect more than those with symptoms (who stay at home or in the hospital). That’s common knowledge.
My dude, if you review the literature (or just google it) you will find that there is common reference to 'subclinical' and 'asymptomatic' COVID-19. First-page google results for 'asymptomatic COVID-19' include an article in The BMJ from four days ago titled 'Covid-19: Asymptomatic cases may not be infectious, Wuhan study indicates.' I'm not saying I buy the findings in that study, but be conservative with what you claim to be 'common knowledge.'
Again, regarding CT values, continuity of positive nasal swab PCR results can be totally divorced from significantly decreased lower-respiratory-tract viral titers, as the Nature monkey paper you sent me pointed out.
I ask you again: What is the mechanism by which a vaccine takes a person who would normally be symptomatic, and magically makes them asymptomatic, while having zero impact on titers of virus in the body?
I'm not talking about behavior here. I'm talking about direct, biochemical mechanisms inside of the human body.
The vaccine is reducing viral titers. And by reducing viral titers, it is reducing shedding into the lower airway. And by reducing shedding into the lower airway, it is reducing the number of viral particles contained in respiratory droplets expelled from the airway. And by reducing the number of viral particles that exit that airway, it is reducing transmission as it is intended.
Behavior is a separate discussion entirely, but consider the mechanism I have described. It is not only reducing viral titers in those who would normally be symptomatic, it is also reducing viral titers in those who would normally be asymptomatic. Those silent carriers that are walking around among us, well, now they're walking around spreading a hell of a lot less virus. And that is a big deal, especially in places like Oklahoma, Idaho, Arizona, South Dakota, Wyoming, Florida, Tennessee, Georgia, South Carolina, etc, which as I mentioned earlier, have zero state-level requirement for anyone to wear a mask at all.
You are claiming [or at least not refuting svrb's argument] that vaccines have no impact on titers of virus in the body, and yet somehow they magically render people asymptomatic by a mechanism as-yet unknown to biology.
That's just not how it works. And the fact that vaccines knock down the amount of virus being spread around is a big deal, especially in places where there are no mask requirements in place.
Earlier you accused me of spreading false information, and asked me to apologize for spreading beliefs that can put people in danger, but have you come to see that this discussion is not as clear-cut and binary as you originally made it seem?
The reality is exactly the opposite of what you claim: all the studies of infectiousness of SARS-CoV-2, and even of other respiratory viruses correlate with detection of high virus load in the upper respiratory tract, and don't correlate with the detection of the high virus load in the lower respiratory tract. Here the most recent meta-analysis of the most relevant studies:
Your reasoning therefore completely doesn't match the results of many different studies across the world, and also doesn't fit with which people are considered infectious in practice, with all the millions of people involved.
So, the study that I've quoted earlier, which detected high viral load in the upper respiratory tract of non-human primate animal model therefore suggests exactly what I've already mentioned that it suggests, namely, that we can not assume that vaccine provides sterilizing immunity unless the later studies with humans show otherwise. And that is exactly how the UK is going to proceed with their vaccination policy, as I've already documented, and also matches the statement of Pfizer's CEO.
(I also note that you again try to insinuate that my claims are something that I've never even mentioned, hoping to change the topic. Please don't.)
Dude. This paper you're sending me is saying exactly what I'm saying. My reasoning matches all of the papers you've sent me so far:
You're saying:
> "all the studies of infectiousness of SARS-CoV-2, and even of other respiratory viruses correlate with detection of high virus load in the upper respiratory tract"
But, RNA fragments detected by PCR in nasal swabs != live, infectious virus.
The paper you linked is saying, instead:
"Our study shows that despite evidence of prolonged SARS-CoV-2 RNA shedding in respiratory and stool samples, viable virus appears to be short-lived. Therefore, RNA detection cannot be used to infer infectiousness."
"Our findings suggest that, although patients with SARS-CoV-2 infection might have prolonged RNA shedding of up to 83 days in upper respiratory tract infection, no live virus was isolated from culture beyond day 9 of symptoms despite persistently high viral RNA loads."
Residual RNA from lysed cells is sticking around and getting picked up on nasal swabs even when actual, infectious, titers of virus in the body are plummeting, and patients are no longer infectious. I used to work with RNA in a research lab! The shit is everywhere. Our experiments used to get contaminated with RNA from the lab next door all the time. I used to have to spray my bench with a bleach solution every day, sanitize my pipettes, and work at night so my RT-PCR experiments didn't get contaminated. That's in the air. Imagine how long it hangs out in the moist, snotty environment of the nasal cavity.
"Nevertheless, most studies demonstrate faster viral clearance among asymptomatic individuals than those who are symptomatic."
"This finding is in keeping with viral kinetics observed with other respiratory viruses such as influenza and MERS-CoV, in which people with asymptomatic infection have a shorter duration of viral shedding than symptomatic individuals."
Giving these people a vaccine will help them clear the infection even faster, which will help reduce community transmission, especially in places where they're now wandering around without masks on, in full compliance with state law.
I'm happy that the UK is prepared to make aggressive and forward-thinking health policy. Good for the UK, but this ain't the UK. There are a lot of countries like the US where I live, as well as my neighbor Mexico that don't have an NHS, and don't live on a small island with a well-functioning government. These vaccines will help to reduce community transmission in places where the scenes from urban hospitals can best be described as nightmarish.
"No part of the world has been as devastated by the pandemic as Latin America. Mexico, Brazil, Peru and other Latin American countries — hobbled by weak health systems, severe inequality and government indifference — have several of the highest deaths per capita from the virus in the world.
And unlike in Europe, the United States and many other regions, the outbreak in Latin American has not struck in waves. It hit furiously in the spring and has continued for months, with few of the respites savored elsewhere, however briefly, around the world. By the first week of September, the 10 countries with the highest deaths per capita were all in Latin America or the Caribbean."
Again, shift your frame of reference. The rest of the world does not look like the UK and Europe. Enjoy living somewhere that isn't a charnel house. The vaccines reduce community transmission, and I can say that confidently because I have outlined a pretty clear mechanism for it and there is zero data you ...
The paper, and the papers it references, disproves your wrong theory that you repeated many times in more messages on this page about "lower respiratory tract" being more relevant for virus transmission, which is still wrong, as in, completely the opposite of what is reported in the scientific papers.
I show you the findings about upper respiratory tract, you then cite "respiratory and stool samples" sentence from the paper as if it somehow disproves what is supported by the paper and the ones it references, that the high viral load in the upper respiratory tract before symptoms and during the first days of symptoms is critical.
You cherry pick the sentence about the "viable virus" not being present "beyond day 9 of symptoms" (meaning day > 9) but that doesn't disprove what is claimed in the studies: that the transmission occurs even before symptoms (days -2 -1 and 0) and during the first few days of symptoms, that is, before the host's immune system has the time to fight the virus infection.
The scientific facts aren't less true in the US than in the UK and Europe. Your claim that you "used bleach solution" in the lab also doesn't make your wrong theory and your other wrong claims less wrong. Of course PCR tests detect RNA longer than the infectious virus is present, but all studies I've cited haven't ignored that fact.
Can you cite specific sentences from the paper that disprove my hypothesis?
I pulled and quoted specific sentences so you didn't have to dig through the paper to see what I'm talking about.
If I'm wrong, and the paper clearly says how I'm wrong, pull the specific sentences and show me. Then I don't have to dig through a research paper trying to guess what you're seeing in there that makes you think I'm wrong. I've outlined a specific mechanism, you can pull things from the papers and refute my mechanism line-by-line if you want. I'm not being vague about anything. I'm spelling it out pretty clearly. If I'm wrong, show me how I'm wrong and then I and everyone reading this will be able to see clearly how I'm wrong.
> "I show you the findings about upper respiratory tract, you then cite "respiratory and stool samples" sentence from the paper as if it somehow disproves what is supported by the paper and the ones it references, that the high viral load in the upper respiratory tract before symptoms and during the first days of symptoms is critical."
I haven't seen any other method of measuring viral load in the upper respiratory tract than PCR. Maybe I've missed something? But in the lower airway they're using lavage in live animals and tissue immunohistochemistry in sacrificed animals to determine actual viral load. So, we don't actually know viral load in the upper respiratory tract from nasal swab PCR specimens (since, as they mentioned in the last paper, PCR from nasal swab doesn't actually correlate with viral load). Do you know of a way that they're measuring upper respiratory tract viral load other than nasal swab PCR?
The point of the bleach anecdote is to highlight what this paper said, which is that you can't estimate viral load based on nasal swab PCR since very high levels of mRNA hang out in the snout for long past the time when infectious viral titers have diminished.
> I haven't seen any other method of measuring viral load in the upper respiratory tract than PCR.
So we came to the truth: you didn't try to read how the researchers perform their research, even if they do publish their methods in the few papers you argue against, but you still claim here you know more than they do.
Of course the researchers can and do establish in their papers how much there's infectious virus in the upper tract. It's just a practical trade-off that, on the mass scale of all the millions of tests daily for clinical purposes, only PCR tests are preformed.
I've given you a single meta-analysis paper instead of linking to all the papers that paper refers to. Whichever detail you'd like to know, the paper links to them. It's mostly a click away. Almost all papers are also open access, meaning that you can read them in full. Moreover, for even those which aren't open access, typically the "appendices" are open access, exactly the parts that describe the methods used in the paper.
So, yes, we do know the actual viral loads of infectious virus good enough (1) to conclude what I wrote. And the conclusions, dumbed down enough, are what I've written before and eventually they can, when we're lucky, even end in the policies in the UK and statements of Pfizer CEO: there's enough research right now to not assume sterilizing immunity, unless the future studies show something else. That's science, it's seldom 100% certainty in 100% of effect.
You can either write about bleach all day or you can try searching in the paper and the references for what you want to know if you really want to learn something. Fishing for single sentences out of the context that support your wrong theories while claiming you know more than the majority of researchers is dishonest and contra-productive, unless you really just want to waste time of everybody (there are actually people paid to do that too, unfortunately).
---
1) Even for a single patient the actual existence of infectious virus can be established and the paper published: https://www.cell.com/cell/fulltext/S0092-8674(20)31456-2 "(SARS-CoV-2) shedding was observed from the upper respiratory tract of a female immunocompromised individual" ... "Shedding of infectious SARS-CoV-2 was observed up to 70 days" Yes, "upper respiratory tract" and "infectious SARS-CoV-2."
I have been reading the papers, I'm just giving you the benefit of the doubt of having read them and seen something I missed. I read scientific papers in biology all the time over the course of making a living, and I know how difficult they are to actually understand and interpret. I see PhDs and MDs make mistakes in interpreting them all the time. I make mistakes and miss things when reading them all the time. That's why graduate students, and professors, and medical residents, and doctors often read and discuss them in journal clubs, seminars, and conferences. The process is very similar to what we are doing right now.
I just read the paper you cited there. They're not determining titers of infectious virus in the upper respiratory tract with any other method than PCR. So, yeah, I'm right. I had just assumed you had read the papers and seen something I missed. You're making me second-guess myself, but I'm doing a pretty good job of cruising through these papers and understanding what they're actually doing.
Again, from the other paper you sent me, "RNA detection cannot be used to infer infectiousness."
The Pfizer CEO, Albert Bourla is a 'business executive and veterinarian."
Uğur Şahin MD, chief executive of Germany’s BioNTech, and whose main fields of research are cancer and immunology, and whose company actually developed the underlying technology of the mRNA vaccine jointly released with Pfizer had this to say:
'"I'm very confident that transmission between people will be reduced by such a highly effective vaccine - maybe not 90% but maybe 50% - but we should not forget that even that could result in a dramatic reduction of the pandemic spread," he said.'
I'm measuring my interpretation relative to actual scientists. Not just a random CEO who held a press conference. Albert, although he probably doesn't have as deep an understanding of the biology as Uğur, probably knows a hell of a lot more about manufacturing processes, and global distribution networks.
Imagine reducing asymptomatic transmission by 50%! That's insane. That's so awesome! It's going to cut transmission of this virus in half, even by a conservative estimate.
If I was able to sit down with Uğur, (who obviously has a much deeper understanding of the mechanism of action than I do) I'm willing to bet that his mechanism isn't so different than mine. Sounds like he and I agree on a lot!
The papers I've read use virus growth in cells, and even electron microscopy. I don't even know how you managed to claim now that only PCR is used in all the relevant papers.
It's no use for me even trying to discuss with you when your "reading" ends with recognizing that some paper mentions "PCR" and then claiming you're right in general, and all the epidemiologists and virologists aren't.
Anyway, AstraZeneca study just came out, and apparently even when the vaccine efficacy was 90%, the number of asymptomatic cases in the group where that was also measured dropped only 27% percent, which suggest again that the societies can't depend on vaccine providing sterilizing immunity -- it still appears that the vaccinated will be able to transmit the virus, just like the materials that I've referred to suggested.
That's why the UK starts with vaccinating first the most vulnerable, they know it's about protecting from illness, not about making the vaccinated impossible to transmit, as it's covered in many news in the UK -- the expectation is that, at the end, the immunity of population will only be reached once everybody is vaccinated. You can claim that nobody but you gets it, and that your "theory" is better than what's observed in many papers, but it's also a certain symptom.
Can't measure viral titer with an electron microscope. All the papers are measuring viral titer in the upper airway with PCR.
They may be confirming virus is present with other technologies, but the only way they're measuring viral titer is with PCR.
I don't claim that nobody but me gets it. The head of BioNTech seems to be saying exactly what I'm saying. I don't claim to say anything different from him.
Let's both come together to draft a public health statement that we both would feel comfortable releasing to the public. I'll go first:
Although new vaccine technologies will (1) aid in preventing members of the public from becoming severely ill with COVID-19, (2) will help significantly reduce the number of people contracting the virus in a clinically meaningful sense, and (3) will help to significantly reduce transmission in a community setting, it will be important for members of the public to continue wearing masks and maintaining social distancing until such a significant portion of the population is vaccinated that infection rates as-measured by nasal-swab PCR begin to show significant decreases, and ICU capacity is restored. Based on this, we will incrementally re-open and relax restrictions as deemed appropriate.
I have much more "down to the ground" practical considerations: I don't directly think about some abstract "ICU capacity" or abstract "nasal swabs" meaning too much but:
1) can I or somebody else transmit the virus to somebody I care about and cause them to end on the ICU or die and
2) I know that no country actually measures "infection rates" with PCR but uses that only as a tool to count the "confirmed cases", where a lot of "confirmed cases" are anyway in bad enough state to need hospitalization (meaning it's expected the will need at least something like oxygenation in hospital, if not intubation in the ICU). I also know that there are cases where the CT scan directly shows that somebody is a "case" even if the repeated PCR is negative. So I don't worry too much about the PCR alone, it's just one of the tools.
I also know that some of those who come in contact with the vulnerable which I know will very probably get the vaccine much earlier then I will. I know they will have to behave like they aren't vaccinated, and I know it will be hard for them to accept that, like it was for you to even agree it's a real problem.
I also know that I personally will have to be potentially careful not to think that I can't transmit to somebody who is in worse shape than me, even once I am vaccinated. I know that even if the vaccine has 95% efficacy, it doesn't mean that somebody I care about isn't in the remaining 5%. I also won't know if I am not in the remaining 5% and pre-symptomatic exactly in that moment. And like I've written, it can be it's even worse, and we have to assume that until the studies show otherwise.
And on the higher level, I have to care about everybody actually: as long as the disease spreads, everybody is worse off. The sooner the broad measures don't have to restrict any activity, the better for everybody. I want the real "recovery" as soon as possible.
So what will I do?
a) follow the results of the ongoing studies hoping for some better news, but not assuming everything simply has to be perfect.
b) prepare myself and those I want to remain in contact with that we'll have to be as careful as we are now until there's simply much less prevalence. If I were in Australia now I'd allow myself much more than I will do for some months here where the prevalence (number of people who are new cases every day) is what it is (and it's similar in a big part of the Western world). So I expect that it will be quite hard for everybody for more coming months.
c) try to make as much people as possible understand that the vaccine is almost surely (even with 95% efficacy it's 1 of 20 for whom it's not "working") not something giving them any new "powers." The more are aware of that, there's bigger chance that the prevalence will go down earlier, and that will protect everybody sooner. And it will save some lives, maybe exactly those I know.
In short, it will be very obvious that it's significantly "better" once when the prevalence goes down to something like Australia (7 new cases today among 25 million people, hey! But it's Summer there) and people I care about (including me) are vaccinated. And that "better" won't start at the moment anybody particular has received the vaccine while the prevalence is still much higher. Vaccine simply won't be a magical shield for any single person, as long as the prevalence isn't low. Which is why always more experts now also say that we should do vaccine trials for the children and if needed start vaccinating them too from some point on (once the trials confirm it's safe and the prevalence still exists). I know people who will surely try to be in close contact with their grandchildren before the risk for them is actually low enough.
We will also have to be careful to observe the prevalence in context of how much measures ...
I'd also like to provide a different perspective from another scientist at Pfizer/BioNTech.
While Mr. Bourla is a 'business executive and veterinarian', another member of the Pfizer/BioNTech team has a different perspective.
Uğur Şahin MD, chief executive of Germany’s BioNTech, whose main field of research is cancer research and immunology, and whose company actually developed the underlying technology of the mRNA vaccine jointly released with Pfizer had this to say:
'“I’m very confident that transmission between people will be reduced by such a highly effective vaccine — maybe not 90% but maybe 50%,” he said.'
He is wwwaaaayyyyy more qualified to have insight into the efficacy of the vaccine than a CEO and vet who has never done research in or treated human patients in the field of immunology.
Seems like mostly a non issue, even if their model is correct. If you have a 10% chance of the vaccine being ineffective for an individual, then the vaccine is still about 85% effective for that population, which is more than enough to pull the R values well below 1.
I imagine it may not be that simple, given the segregation of ethnic populations. I.e., people probably interact more frequently and closely with others of the same ethnicity, so the average effectiveness may not be sufficient.
As long as you don't take things personally, arguing with folks on the internet who disagree with you is a great way to find potential weaknesses in your own arguments, and ultimately to shape and strengthen them in unexpected ways.
It's like going to the gym, but it prepares you to have face-to-face discussions with real-world people whose opinions you actually care about, rather than strangers on the internet.
I've been downvoted, and disagreed with many times, but I can't say I didn't learn something new each time, even if it was about something as basic as the way I phrase comments.
Cheer up, maybe you were completely right, and other people just didn't quite get what you were saying!
Some interesting remarks to put in context before judging this MIT claim as true or false:
- Racial bias in medical research is real and methods for increasing fairness are urgently needed in clinical trials
- We don't know for sure how racial bias was balanced on most phase 3 trials, because most research protocols were not disclosed to the science community
- Since efficacy was measured by the sub population in the phase 3 trials who got infected, we can perhaps have other confounding factors who can affect more, or less, some ethnicities (for example, someone can raise the hypothesis that some cultures are more prone to use masks and keep distancing, reducing inherent risks, and that can be true)
- Sample sizes for the phase 3 studies so far very small (perhaps enough to assess minimal efficacy?) for ANY race/ethnicity. We hope that with the increase of the vaccinated population we can have a more precise estimate
- We are talking about 95% inside a confidence interval which is still uncertain lower/higher boundaries, given the small sample
- It is very dangerous to claim any statistical conclusion with small sample sizes
- Almost all "advanced machine learning AI methods" fail miserably. And they fail even worse with small datasets (which is the case). Examples are the handful of "covid pollsters" we got since the beginning of 2020, trying to guess how many people would die, or get infected.
- About vaccine efficacy in asians - we should monitor phase 3 results of CoronaVac (the chinese vaccine) trials (which are in course in China, Brazil and other countries), so we can account for these biases. I heard these results are coming in the next few weeks
Also, the main purpose of a vaccine is herd immunity.
If a large enough majority of the population become immune that we achieve herd immunity, that will still protect the minority of people for whom the vaccine didn't work.
No, at the moment "the main purpose of a vaccine" is still not "herd immunity" at all. The Phase 3 trial protocols measured and presented the "efficacy" which is defined as the reducing the chance of the vaccinated getting sick -- that is, merely reducing the severity of disease among those who were vaccinated.
"In an ideal world, a vaccine would prevent infection entirely and, it follows, also prevent disease and severe disease. But this may be hard to achieve for a respiratory virus vaccine. Animal challenge data suggest that vaccinated animals may still be infected even if they don't experience symptoms. A vaccine that is able to reduce the severity of disease, even if it cannot prevent infection entirely, would obviously still have enormous public health value. Therefore, this is what trials target as their primary aim."
Not all vaccines are the same.
For mumps, totally different kind of disease, to prevent an outbreak, there was a following calculation:
"since one in 10 vaccinated people are still susceptible to mumps, an overall vaccination rate of 96 percent is needed to prevent an outbreak"
For Covid-19, to note from the first source again:
"A vaccine that is able to reduce the severity of disease, even if it cannot prevent infection entirely, would obviously still have enormous public health value. Therefore, this is what trials target as their primary aim."
Yes and no. These vaccines have been formally tested for their ability to protect the recipient, & there is some unquantifiable risk that they'll still get harmless-to-themselves mild infections – especially nasal/mucosal/surface infections – that can still transmit to others.
But it's reasonable to also expect the following to be shown when there's more time:
* The milder infection makes such infections less transmissible (in terms of duration-of-infectiousness of quantity-of-sheddding)
* such superficial infections in the vaccinated don't recur often, or as they recur become ever-milder – because the nasal/mucosal surfaces themselves eventually improve their immunity. So, an extra step is required to achieve the simplified idea of 'herd immunity', but the vaccines is still one step in that direction.
So it is still very much the hope & eventual aim of these vaccines to keep enough people alive, with mild easily-recovered infections, that 'herd immunity' (and thus much-lower or almost non-existent rates of infection even in the unvaccinated) is reached.
> But it's reasonable to also expect ... - The milder infection makes such infections less transmissible (in terms of duration-of-infectiousness of quantity-of-sheddding)
Neither reduced duration of infectiousness nor reduced quantity of shedding by definition protects the vulnerable.
It can reduce the speed of spread, but that by definition doesn't even mean that a vaccinated person can visit their non-vaccinated or immune suppressed relative without the mask.
For all we know the "quantity of shedding" has to be very low for transmission to provably not occur -- some experts estimate that a single droplet containing only 500 viruses is enough. To compare, the typical tests measure the presence of virus RNA starting with many millions in the sample and the tests do detect asymptomatic persons -- those who don't get sick now.
> superficial infections in the vaccinated don't recur often
From the studies of other coronaviruses it is known that infections do recur.
And finally, we even know that even some percentage of people who get the vaccine become the disease later and are observably sick -- that's the difference to 100 to efficacy percentage (e.g. 5 of 100 who received the vaccine, or every 20th, if the efficacy is 95%).
And we can also expect effectiveness (protection of the vaccine in the real world) to be lower than efficacy (reported from trials).
In short, for all we know at the moment, the life will continue to be hard for those who don't get the vaccine and those whose immune system can't respond to the vaccine.
> Neither reduced duration of infectiousness nor reduced quantity of shedding by definition protects the vulnerable.
Everything which reduces community prevalence (& case replication rates) protects the vulnerable, at least indirectly.
Briefer and lesser shedding of infectious material is also likely to also contribute to milder cases among the unvaccinated - so they acquire natural-recovered immunity, both surface-mucosal and deep, over time with fewer risks to themselves & others.
You are correct that simply having recently completed an initial vaccination should not give anyone confidence to immediately visit a vulnerable, unvaccinated person. After all, a surface/mucosal/sub-symptomatic infection that's still transmissible remains a possibility, especially while community infection rates are high.
But 6-12 months later, when infection rates are low, and it's quite possible the vaccinated person has already been mucosally-challenged by naturally-circulating virus? At that point, the net effect of vaccines-over-time means the risk of such visits to the non-immune likely returns to the same baseline level that they had in 2018 and before, from everpresent pneumonia/flu concerns.
> And we can also expect effectiveness (protection of the vaccine in the real world) to be lower than efficacy (reported from trials).
It could go either way. Even in trials attempting blinding, often the vaccinated have a strong hunch (from side effects) they've received the active vaccine - and so take more risks than the placebo arm, thus causing the trial to underestimate actual protectiveness.
Also, to the extent early vaccinations could be well-allocated to either most-vulnerable or most-likely-to-spread – subgroups that weren't overweighted in the trials – they could show more effectiveness in disease-prevention.
And this only improves as herd immunity grows: in a tiny trial, others' vaccinations have little indirect protective effect, but as immunity rates rise in the community, there's a compounding benefit.
You can't have T-cells and antibodies covering every single potential surface area of every cell of every tissue in the body, so there can be places that are infected in the body even though you're totally subclinical and not shedding in a meaningful sense. But such a small infection that is effectively managed by a vaccine-primed immune system is meaningless. That's like saying that a clean living-room floor isn't really clean because you can spot a speck of dust with your magnifying glass.
For all intents and purposes, vaccines prevent people from contracting an infection that is clinically meaningful, and that can be spread to others in a way that leads to infection. That's herd immunity.
"Herd immunity is a form of indirect protection from infectious disease that occurs when a sufficient percentage of a population has become immune to an infection, whether through vaccination or previous infections, thereby reducing the likelihood of infection for individuals who lack immunity."
> You can't have T-cells and antibodies covering every single potential surface area of every cell of every tissue in the body, so there can be places that are infected in the body even though you're totally subclinical
That is exactly the mechanism how non-sterilizing protection by vaccines for respiratory diseases occurs: the cells in mucosa in the upper respiratory tract are infected every time one is exposed to the virus before the antibodies can respond. The mucosal cells shed the virus even if the infection doesn't have to result in symptoms. The viral shedding is however high enough to allow transmission to the unprotected.
Note that at this very moment there are still no reports of a vaccine inducing sterilizing immunity, especially in nasal mucosa.
Up to now, for the vaccines which reported the efficacy, it was by design measured and reported as protection to the symptoms of the disease. The press releases take care to mention "efficacy according to the primary study objective", where just "protection from Covid-19" (as in: from the disease with defined symptoms) was reported. Not the sterilizing immunity. (2)
"Challenge studies in vaccinated primates showed reductions in pathology, symptoms, and viral load in the lower respiratory tract but failed to elicit sterilising immunity in the upper airways." (1)
"These observations suggest that we cannot assume COVID-19 vaccines, even if shown to be effective in reducing severity of disease, will reduce virus transmission to a comparable degree. The notion that COVID-19-vaccine-induced population immunity will allow a return to pre-COVID-19 “normalcy” might be based on illusory assumptions."
"Crucially, it will be important to communicate to policy makers and the general public that first-generation vaccines are only one tool in the overall public health response to COVID-19 and unlikely to be the ultimate solution that many expect."
(Note: All cited here are the papers directly studying Covid-19, which are far more relevant in this case than a wikipedia article about what "herd immunity" were, when and if it exists.)
So, are you saying that meaningful (not perfect) herd immunity is impossible for any respiratory viral infection, even in the presence of a vaccine that generates a robust T and B cell response?
Also, regarding the nasal swabs in those monkeys in the nature paper, you're not spraying respiratory droplets all over the place out of your nose when you vocalize. It's coming out of your trachea and oropharynx as those vocal cords vibrate and air gets pushed out of the lower airway. You don't sneeze at the grocery store cashier whether you want paper or plastic.
"We observed a significantly reduced viral load in the bronchoalveolar lavage fluid and lower respiratory tract tissue of vaccinated rhesus macaques that were challenged with SARS-CoV-2 compared with control animals"
That's a HUGE win in reducing transmission.
Come on, you gotta be a little more enthusiastic here! These vaccines getting out there are going to have a MASSIVE impact on knocking down this pandemic.
The vaccines will reduce the visible effects of pandemic, that's sure, by reducing the numbers of those who will have to be admitted to the hospital. In Covid-19 a huge percentage of people who get infected currently have to be hospitalized, and reducing that number will help a lot.
What we still can't expect, until we have some different and exact information, is to be able to visit our non-vaccinated or immune suppressed relatives and friends without a mask and be really sure that we can't infect them as long as the incidence is high enough. What we currently know says the opposite: no proof of sterilizing immunity by the current vaccines, and animal studies which show the same viral load in upper respiratory tract mucosa.
That's what I personally worry about, I have such people and I don't want them to die because of the, at the moment still unfounded, belief of some (like "phobosanomaly" who uses totally irrelevant quotations to support their claims) that the vaccine must have "sterilizing immunity" while the experts are cautions to point that the currently available information surely doesn't support that.
And if "phobosanomaly" now also doesn't claim at the moment that the vaccines have such property but merely that the transmission will be "reduced" then I don't disagree with that. But for me "transmission will be reduced" as this moment still means "we can't even assume that the vulnerable can't become infected from those who already received the vaccine."
Also note that the distribution of those who get the vaccine but then still become ill (1 of 20 by Pfizer and Moderna trials) will also not be evenly distributed across the population. That means that if you know even less vulnerable people, you can expect that some of them won't be protected even if they can and do receive the vaccine. I worry also for those.
If you also maybe believe that the vulnerable are disposable because they are old and not productive anymore or something like that, I can assure you that I personally know young and worthy people who can still contribute a lot to the world but who can surely be considered vulnerable, and who surely aren't doing anything wrong, who aren't overweight and who are doing sports regularly.
And finally, I admit I also worry for those who I know who are considered "older" but whose number of days on this planet can also be seriously affected by the attitudes of those who want to believe only that what is convenient to them, even if it is completely opposite of what is currently known.
There are 200,000 new cases in the United States every day, and nearly 3,000 people dying from this every day. This vaccine will help to arrest the free-fall, and help us get this whole thing under control. It will restore ICU capacity, and open-up hospitals again, so that those with immunocompromised conditions (alongside a hell of a lot of other conditions) will finally be able to get in to see their doctor. It will also stop killing their doctors.
I assure you that your immunocompromised friends and family will benefit significantly from getting people vaccinated, in the same way that they currently benefit from vaccination campaigns surrounding seasonal influenza. Not only that, I'm sure your severely immunocompromised friends and family will appreciate actually being able to get their hands on N95s again.
If your friends and family are that immunocompromised, you should be wearing a mask around them anyway, because they're very vulnerable to a hell of a lot more bugs that you could be toting around than just SARS-Cov-2 .
But, understand that if you live in the United States, there are thousands and thousands of people dying every day from a raging, uncontrolled pandemic that a significant percentage of the population has chosen to simply ignore. I am not the enemy here man. If you think the enemy is someone on HackerNews who actually takes the time to read the papers you cite, you need to take a trip to an Oklahoma WalMart.
Remember, I'm not the guy you need to convince to be cautious. I'm the guy advocating the public health benefits of vaccination, not the guy running around telling people that masks are for pussies and that vaccines will give you autism. You have to have a sense of perspective about this whole thing.
These vaccines are awesome. They are literally a wonder of modern biotechnology. This technology is pretty much completely novel! This is a net plus for the entire human species.
I'm not denying the known awesomeness of vaccines. I'm denying your currently provably false claims about the extent of their awesomeness, and I've linked to the proofs and specified exactly what you have claimed but what's provably not supported at the moment. I see you don't try anymore to claim what you initially claimed, and that's good.
Your claim "you should be wearing a mask around them anyway, because they're very vulnerable to a hell of a lot more bugs that you could be toting around than just SARS-Cov-2" is also wrong. It's also provable, and was easy to read in the press for months, that many people who would otherwise live decades longer, without people around them wearing masks, already died form SARS-Cov-2. There are still many such who have tried to protect themselves in these months but who will be more exposed to those who would wrongly believe in "sterilizing immunity" of the vaccine if there is no such.
So it's important to be scientifically accurate. At the current moment, all we know is that the vaccines protect the vaccinated from getting sick. We still don't know that the vaccinated can't transmit the virus to the vulnerable, and until we know that, we must say that we don't know that and protect the vulnerable!
"So when facing loss of innocent life in a house fire, cry openly. Allow yourself to hurt deeply. Comfort the bereaved. But don’t say “it was meant to be” or “they’re in a better place.” Go out and promote stoves with smoke-sensing, automatic shut-off valves. The fact that we have the ability, through conscious choice and action, to change the world and make it a better place is a fundamental wonder of being human. It’s what being good is. Not for the benefit of some other world, but for this, our one world; not for some supernatural being, but for our fellow beings."
I still don't buy the evidence you've given. Sure, there's not hard clinical evidence that I can point to that demonstrates that there is zero viral shedding from vaccinated individuals. But I don't claim that. I claim that it is highly likely that it knocks down viral shedding significantly. My reading of the monkey paper you cited earlier demonstrates to me a clear mechanism for reduction in viral shedding through the lower airway, thus reducing viral transmission through respiratory droplets during vocalization!
I don't think you're drawing a distinction between pathologically immunocompromised individuals, and individuals who may not have as robust an immune response as others, but who can receive a vaccine. In someone who is pathologically immunocompromised, you should 100% be wearing a mask around them normally. They are not safe if you do not because they are vulnerable to a wide number of pathogens. If they are simply elderly or at-risk, let's get them vaccinated!
My mom is elderly and very vulnerable, but she is not pathologically immunocompromised. She has a reaction to flu vaccines. I will most definitely be recommending to her that she receive either the Pfizer or the Moderna vaccine. There may be an adverse reaction, but she'll be a hell of a lot safer than if she didn't receive the vaccine and catches COVID. At some point people will stop wearing masks in the community (Neither you nor I have any control over this), and she will have to decide for herself if she chooses to enter the community unmasked, or if she will wear an N95 for the rest of her life.
And, as I mentioned earlier, at the end of the day, what will happen will happen. Do you think the United States will go into a full China-style lockdown at some point to protect people who are unvaccinated after the vaccine has reached wide distribution? It's not gonna happen! It doesn't matter how either of us feels about this. It's just not gonna happen. The best plan we have for moving forward is to get as many people as we possibly can vaccinated. Based on my understanding of immunological mechanisms I believe that it is highly likely this will reduce community-transmission (you haven't convinced me to let go of my suspicion based on the evidence presented, and I think the monkey paper in fact strengthens my argument). For those that refuse to be vaccinated, or that are pathologically immunocompromised, their best bet will be increased access to N95 masks to actually filter incoming air, and the fact that they will once again have increased access to the healthcare system that they do not now have.
What is your alternate proposal? Do you think the US will lock-down and mandate masks for the next 10 years, even after widespread vaccine distribution? Remember, we are not talking about science here, we are talking about policy. And despite Dr. Rifkin's faith in the angels of our better nature, and that "Our non-rational sides should inspire and inform reality, not dictate our perception of it," again, I invite you both to visit an Oklahoma WalMart and confront the fact that policy does not follow these humanitarian ideals. To quote from Ben Rhodes' memoir, "We take the world as it is, not as we wish it to be."
You write: “Remember, we are not talking about science here, we are talking about policy” but, sorry, no, in many messages you just kept claiming the opposite of what is scientifically known at this very moment, and I’ve pointed to that false claim and gave you the quotes and the original vaccine tests protocols. Now the whole country is warned as explicitly as possible, most probably even with legal consequences to those who act against:
1) You should apologize for spreading the beliefs that can put people in danger and stop doing that.
2) Understand what's currently scientifically known, and avoid spreading misinformation.
3) Regarding what the policy should be: allow the science to do its work instead promoting measures or beliefs that can put people in danger. The world had enough of that for months. Vaccines are good and should be used, but not believing what you promoted -- not behaving as the immunity provided by the vaccine was higher than what's known at the moment.
Don't worry. Nobody else is reading this thread at this point. It's you, me, and svrb. You can relax. I'm not a clinician or an epidemiologist, and based on your arguments I don't think you are either, so the stakes are low. We're just having fun debating on the internet.
I'll put in a disclaimer if it will help you sleep better at night: "At no point in this obscure thread in the dark corners of HackerNews does phobosanomaly advocate that within 10 months of receiving a SARS-CoV-2 vaccine should you be coughing on your elderly and comorbid friends and family who have not received a vaccine. Instead, you should bug them to get vaccinated as soon as possible!"
Having a scientific hypothesis isn't a license to do stupid shit. I assumed I didn't have to spell that out.
With regards to this: "Now the whole country is warned as explicitly as possible." I guess you're in the UK. I live in the USA, and it's a whole different ballgame over here. I don't think you quite understand my Oklahoma WalMart comment. There are people in Oklahoma WalMarts who refuse to wear a mask, and who open-carry handguns in case anyone tries to force them to. That is perfectly legal in this country, and very common depending on where you are. I think we're arguing from a totally different frame of reference when considering matters of policy. The United States is in complete free-fall, and there are places here where you can get shot for requiring someone to wear a mask. I am more concerned with triage, than the fine details of what happens once a significant percentage of the population is vaccinated. You must understand just how bad it is here.
That's why I was astonished about how passionate you are about the fine details of this. We do not have a vaccine here. 3,000 people are dying every day. We have lost 276,000 people already. ICUs are at capacity. There are entire swaths of the population who do not believe the virus is real. We have no NHS. There is no vaccine distribution network. There is no plan. There is no-one in charge. Our president is currently occupied with trying to overturn our last presidential election. Mask compliance in massive parts of this country is a pipedream, so to be concerned about whether there will be mask compliance after widespread vaccine distribution seems utterly absurd. We're hoping we can actually get a vaccine distributed in the first place, and still trying to get people to wear masks to begin with. I need you to understand that in the entire state of Oklahoma, there is no requirement to wear masks at all, and the governor has instead proposed that the state have a day of prayer as a solution.
Shift your frame of reference. I am not the enemy. You haven't the foggiest clue of the degree to which I am not the enemy.
2)
I get what is currently known. There is no definitive randomized clinical trial that clearly demonstrates that a person vaccinated with the Moderna or Pfizer vaccine can in no conceivable situation spread virus to others. The public health officials you quote are saying just that. I don't dispute that at all.
However, the absence of a specific randomized control trial does not mean that I cannot strongly suspect that, as I put it, "it is highly likely that it [the vaccine] knocks down viral shedding significantly." There's a clear mechanism for that, and papers you cited pointed that out. In those monkeys, the vaccine significantly knocked down viral shedding in the lower airway. It seems pretty darn plausible to me.
Are you familiar with the famous parachute study?
"Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9...
Dear authors, if you are reading this message please consider not using the word race.
> Modern scholarship regards race as a social construct, an identity which is assigned based on rules made by society. While partially based on physical similarities within groups, race does not have an inherent physical or biological meaning.
You're right. That would be a counter-example because of non-biological second-order effects.
But in this context, we're talking about first-order biological effects that aren't accounted for because of race. If race doesn't have biological underpinnings then the larger argument is meaningless.
If you replace one word by another with the same meaning, you don't fix the problem : the concept of human races. You can read the Wikipedia article and its many sources if you want to know more on the topic.
"Race" already had a meaning before these "modern scholars" tried to redefine it. If you want to describe ethereal or nonexistent things with some word, go ahead and create your own word.
> the vaccines’ effectiveness may vary depending on a person’s race
There are no races in the human species, due to genetic reasons: the lack of well-delimited genetic clusters (like we see for dogs, cats, cows, horses, etc.) and the large number of inter-group genetic distances that are shorter than intra-group ones.
US geneticists and anthropologists understand all that, but it seems that vast sections of the population are still on board with scientific racism - not very surprising, when official census forms still have separate fields for "race" and "ethnicity".
As a bioinformatician, you ought to be ashamed of yourself for that comment. Is your grasp of biology truly that poor? The sheer gall of that comment. This is a forum of experts at building web apps and premature optimization. The average reader here knows next to nothing about genetics and cell biology. Spreading incorrect information about biology is contributing to disinformation and fake news.
I am so ashamed of my comment, thanks for pointing that out.
>Spreading incorrect information about biology is contributing to disinformation and fake news.
Really, it is incredible how a one line comment changed the whole universe of fake news and disinformation.
I can also only assume that you are not the average reader here, but some one with higher knowledge in every aspect of life and Science.
Thanks for you comment. I am starting to clean my social media activity and in the next day or two, I will probably kill myself. Thanks for letting me see this, I cannot live with the drastic contributions I made to spread disinformation online.
As a higher being, can you tell me the easiest way to end my life? I am looking for something not painful, and something that would not traumatize my son, as we live together and I work from home.
Again, thanks to make me see the light. Without you, the world would have to endure another fake news spreader. Be assured that my family will send you part of my life insurance, as soon as we get your name and address.
Much of the discussion here centers upon "race" and its use in the headline and in the medical literature. A better term might be "genetic variation" as it has less baggage than "race".
What is significant is genetic variation tends to be geographically distributed. https://www-nature-com.stanford.idm.oclc.org/articles/ng1435. Making a universally effective vaccine needs to start off with a geographically diverse sample of both the virus and the population to be vaccinated.
Unrelated to this, but did they test this vaccine on people that already had COVID? I'm kind of interested to know if antibodies accumulated from having it negate the vaccine or if they interact in any way.
It makes me think about an idea that was heavily criticized in the beginning of the pandemic: to test vaccines in Africa.
I remember a huge uproar: "we are not your guinea pigs". And I totally understand the sentiment. The vaccine will mostly benefit rich white people, while the poor Africans will, as always, get the short end of the stick. And I have no doubt it will happen like that.
But, by refusing trials in your poor country, you basically lower your chances of getting an effective vaccine when it matters from not much to zero. Allowing trials should be a good way to negotiate a way to secure doses for yourself, since you can't do it with money like first world countries. But it is also a way to have the vaccine tested on your population rather than only on white guys.
And sure, there are risks in doing that, but Covid-19 kills in Africa too. I didn't do a risk analysis but I am quite sure it is a net positive for the "guinea pig" countries.
And sure, in an ideal world, we should all work together and treat everyone independent of status and wealth in order to end the global pandemic as quickly as possible. But past events showed us it doesn't work like that. Rich countries fighting to secure resources (tests, masks, vaccines, ...) for themselves. The push for buying domestic products instead of from evil China. The very idea of evil China, partly justified but overblown for patriotic effect... Africa will get nothing but scraps unless they have a bargaining chip, and hosting vaccine trials could have been that chip.
The answer to your dilemma is in the premise: all these companies needed to do was to provide concrete assurances that the testing would net participants a spot in the front of the line and due compensation. That would mean spinning up resource supply chains and infrastructure to make sure not just testing, but actual administration, of the vaccine would happen there. But because of the neglect and exploitation much of Africa has experienced from major powers, that would have turned testing into a prohibitively funding- and time-intensive prospect. African leaders aren't stupid, they recognized that. So without those concrete assurances, any widespread testing would almost certainly have been yet another example of exploitation, where the spoils go north.
And for what? Most African countries are dealing with COVID perfectly fine. Europe and America are the ones where the suffering is disproportionate to the norm. This is not a case of Africa suffering for its lack of desire to play ball with Western powers; it's one where Western powers killed hundreds of thousands of their own citizens unnecessarily. If there's any injustice, it's in that the people paying the price in our countries are the people who get screwed over by institutional neglect - sometimes, sabotage - time and again.
China is actually doing what you're describing with it's vaccine development. It's sort of a geopolitical power move for them, plus they don't have enough people domestically with the virus to run clinical trials anymore.
As well, there's less of a potential PR-hangup for a Chinese company if they have to grease the local wheels with some cash 'donations,' whereas Pfizer and Moderna probably wouldn't want to be caught bribing people in the context of a clinical trial (I used to work for a Chinese immunodiagnostics company that did business in the developing world. It's just how things work some places if you want to enter a market and don't have the right political connections).
It's not Africa-focused particularly, but they're running tons of clinical trials across the developing world, and will give these countries early-access that they would not otherwise have with the Western vaccines.
I'm more than a little suspicious of a bunch of Computer Science folks running some data through their machine learning tool and then trying to tell the vaccine makers they should change their recipe because of it.
Even assuming their data is correct, the variation in effectiveness is 10% and for people in their worst case scenario group it would still be one of the most effective vaccines every created.
Health issues for racial minorities in the US are a result of structural racism, not their genetic makeup. Do vaccines fare worse with minorities because they aren't developed and tested on diverse genetic makeups? Or do they fare worse with people with health issues?
They express it as "racial minorities", but then talk about lower effectiveness on eg "asians", who last time I checked outnumber whites 3:1 or so. I'm guessing the contention isn't that it magically becomes ineffective on a Chinese in Brooklyn as opposed to a Chinese in Beijing, but for some reason they felt the need to communicate their results on a global phenomenon via parochial US racial politics.
> There are obviously many other factors to consider [from the article]
If "effectiveness" is currently being measured as reducing symptoms, could Vitamin D levels be a likely additional factor, known to correlate with ethnicity? Could "low Vit D" plus "no vaccine" be additive toward increased symptoms?
Based on a quick scan of the preprint I see no reference to Vit D.
107 comments
[ 3.3 ms ] story [ 133 ms ] threadNot all vaccines are developed in the US and people who are a minority in the US are not necessarily minorities elsewhere.
Is there a more accurate term I’m not aware of?
For instance, the fact that "minorities" are more susceptible to COVID in the first place (in the US, at least) isn't because of racial makeup or ancestral heritage, but rather because marginalized people in the US are more likely to be in "front line" jobs that come in contact with large groups of people (service workers, hospital janitorial staff, food workers, the like) and much less likely to be in a position to remove themselves or work from home.
We're trying to talk about the vaccine's effectiveness. We're trying to talk about biology, and it's kind of urgent at the moment. Can we please give sociology issues a pass for a bit?
EDIT: apologies HarryHirsch, it was relevant if I just read until the end. You did explain a better way to phrase it. I think you're right that using the word "population" is better here. Good reminder to me to make sure I understand what someone is saying before rejecting them.
> the team found that the number of people whose immune system didn’t robustly respond to the vaccine ranged from less than half of one percent of white participants to nearly 10 percent of Asian participants. ... our preliminary results suggest that, on average, people of Black or Asian ancestry could have a slightly increased risk of vaccine ineffectiveness
It would be more accurate to say that a person's race may have an effect on the effectiveness of a vaccine but it's still relevant to class them as minorities in the places where the effectiveness is being studied. If a vaccine is being studied in a population of 40000 and only 100 of those people are black, you won't be able to learn as much about the vaccine's effects on people of a certain race because of the low sample size. It's of course relevant for those in countries where those races are majority and more studies need to be done in those places as well.
There are some absolutely brilliant scientists in China working on vaccine development right now! Let's stop hand-wringing, this is a global public health issue, not a political issue, and China is working on it too.
"If China’s COVID-19 vaccines work, manufacturers say they could turn out 1.5 billion doses in total next year. And countries that cannot access vaccines bankrolled by Warp Speed—especially those that hosted China’s efficacy trials—might have a more secure vaccine supply."
"Yanzhong Huang, a global health specialist at both Seton Hall University and the Council on Foreign Relations, says the country is “actually using the vaccine to promote the diplomacy of foreign policy objectives.” This “vaccine diplomacy” he says, contrasts starkly with Warp Speed’s “vaccine nationalism” and aims to “fill in the void left by the United States.”
“It is a very carefully executed and carefully thought out strategy,” says Stephen Morrison, who directs the Global Health Policy Center at the Center for Strategic & International Studies. “A strategic goal of the Chinese government is to achieve hegemonic influence in the bioeconomy within the next decade.”
"At home, too, attitudes toward vaccines contrast with those in the United States and Europe, where mistrust is high, Morrison says. To the consternation of vaccine experts overseas, hundreds of thousands of people in China have already lined up to receive the experimental vaccines—even before their value and safety have been proved. “There has not been a collapse of faith and trust in science and in the state,” Morrison says. “There’s less fear about where this is all going.”
https://www.sciencemag.org/news/2020/11/global-push-covid-19...
I'm not a huge fan of a lot of what the Chinese government does, but the U.S. is in the throes of some seriously crazy shit right now, and could take a lesson.
> Gifford and PhD students Ge Liu and Brandon Carter also presented a promising new ML-based approach for improving the vaccines’ effectiveness with certain populations: adding a small number of additional Covid-19 peptides to a given dose of the vaccine.
> The team’s “augmentation” vaccines use vaccine components that have been observed to cause immune system responses in COVID-19 patients. As shown in the below chart, by adding somewhere between 5 and 50 additional peptides to a particular dose, the team says that preliminary tests show that they improved the vaccine’s effectiveness to nearly 100 percent in all populations.
Is adding peptides to a vaccine something that has been done before, or is this new? And how do you add peptides to a vaccine?
> some health experts have expressed caution about the companies’ confident assertions that the vaccines are 95 percent effective for all populations.
Obviously a vaccine isn't going to erase preexisting differences in health outcomes. Closer to a factor on some prior susceptibility (though of course not so cleanly linear in reality).
The article makes it sound like they're not basing their finding on the actual vaccine trial data, so is this hyperbole?
Jesuschrist, stop with this nonsense.
[0]: https://www.pewresearch.org/hispanic/2020/08/11/about-one-in...
However the main purpose of a vaccine is herd immunity.
If a large enough majority of the population become immune that we achieve herd immunity, that will still protect the minority of people for whom the vaccine didn't work.
I assume they mean “racial minorities” with respect to the country whose National Institutes of Health are listed as a sponsor of the research.
Same-same, though.
This is false when it comes to the COVID-19 vaccines under development. They do not—and are not meant to—prevent people from contracting and spreading the virus. They only reduce the symptoms. This does not help herd immunity (other than perhaps allowing the virus to spread faster, I guess).
"COVID-19 mRNA vaccines are given in the upper arm muscle. Once the instructions (mRNA) are inside the muscle cells, the cells use them to make the protein piece. After the protein piece is made, the cell breaks down the instructions and gets rid of them."
"Next, the cell displays the protein piece on its surface. Our immune systems recognize that the protein doesn’t belong there and begin building an immune response and making antibodies, like what happens in natural infection against COVID-19."
"At the end of the process, our bodies have learned how to protect against future infection. The benefit of mRNA vaccines, like all vaccines, is those vaccinated gain this protection without ever having to risk the serious consequences of getting sick with COVID-19."
https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different...
E.g. Moderna protocol:
https://www.modernatx.com/sites/default/files/mRNA-1273-P301...
"To be considered as a case of COVID-19 for the evaluation of the Primary Efficacy Endpoint, the following criteria must be met:
- The participant must have experienced at least TWO of the following systemic symptoms: Fever (≥ 38ºC), chills, myalgia, headache, sore throat, new olfactory and taste disorder(s), OR
- The participant must have experienced at least ONE of the following respiratory signs/symptoms: cough, shortness of breath or difficulty breathing, OR clinical or radiographical evidence of pneumonia; AND
- The participant must have at least one NP swab, nasal swab, or saliva sample (or respiratory sample, if hospitalized) positive for SARS-CoV-2 by RT-PCR."
In some other protocols it's not written in an easily quotable way but spread through the text and tables, but if you analyze the protocols carefully, the goal is the same: it's the vaccinated and symptomatic that are counted and compared with the symptomatic counted in the placebo group.
So whenever you saw "protection" up to now it was implicit it's the protection from the disease as defined above. Not the sterilizing immunity.
Moderna's announcement is also explicit in mentioning so defined "primary endpoint":
https://investors.modernatx.com/news-releases/news-release-d...
"The primary endpoint of the Phase 3 COVE study is based on the analysis of COVID-19 cases confirmed and adjudicated starting two weeks following the second dose of vaccine."
We should eventually know more, but we still don't have that information.
Check out the Pfizer press release. The vaccine is eliciting robust SARS-CoV-2 neutralizing antibodies, as well as T-cell responses.
https://www.pfizer.com/news/press-release/press-release-deta...
That's a direct mechanism of protection that will help to both prevent people from getting sick, and knock down shedding.
You're getting so far off in the details that you're missing the forest for the trees.
That's what the reported numbers claim: up to 95% people less are getting sick.
But it's unknown how much it will "knock down shedding" and the experts who follow only publicly available data are still cautious to claim the opposite of what you claim, specifically:
"it will be important to communicate to policy makers and the general public that first-generation vaccines are only one tool in the overall public health response to COVID-19 and unlikely to be the ultimate solution that many expect."
You may not like that or believe something else, but it's not what I hear and read the mentioned experts say, like, as an example, Natalie E. Dean whose article I've already linked to, and you can follow her other writings too. And, as far as I know, her opinion is far from being untypical, i.e. it would be easy to find more actual experts (which I define as those who were doing active research even before Covid-19 in the field and not something totally unrelated and who aren't just jumping in for political purposes -- note that that definition automatically excludes those like Ioannidis) who publicly say the same.
Of course our response will be a multi-faceted approach! Look at how many businesses are now installing UV-lights in ventilation systems, allowing people to work from home, and how the wearing of masks has become normalized and accepted in many parts of the country!
People will no longer hesitate to throw on a mask if they feel ill, unlike before when we used to wander into Target sneezing and coughing all over everything! Think of how awesome that is for immunocompromised people!
The vaccine will be a critical link in a long chain that will hopefully save thousands, and thousands of lives. Whether it 100% eliminates the shedding of any measurable viral particles, knocks it down by 10%, 20%, 30%, 50% or whatever, it's a huge win. Right now we have zero way to even think about reducing viral shedding in real-world populations. We're relying 100% on social distancing and masks.
Get excited! We're gonna kick this thing!
Meanwhile, exclusive evening news in the UK:
https://news.yahoo.com/exclusive-vaccine-wont-free-self-1656...
https://www.telegraph.co.uk/news/2020/12/03/exclusive-vaccin...
3 December 2020 • 7:00pm
“Exclusive: Coronavirus vaccine won't free you from self-isolation, says Government —- The jabs provide Covid-19 immunity but scientists are yet to prove this prevents recipients from carrying and spreading the virus”
“People who receive the coronavirus vaccine will not be exempted from self-isolation if they are contacted by NHS Test and Trace, it has emerged.
Although the vaccine will give recipients immunity from the virus, scientists do not yet know whether it will stop them being carriers.
Government sources said it was likely to be months before there was any prospect of the vaccine negating the need for self-isolation.
It means that even if someone has been vaccinated, they will still have to remain at home for 14 days if they come into contact with someone who has the virus.”
..
“Any other vaccine that might be approved by regulators, such as the one being developed by Oxford University, will also be subject to the same lengthy process of discovering whether it prevents people being “silent” carriers of the virus.”
Take it up with them if you want.
https://wwwn.cdc.gov/DCS/ContactUs/Form
To be fair, a large portion of the blame lies with whoever wrote the copy for that CDC marketing page, as they are intentionally obscuring the fact that these vaccines do not prevent the spread of the virus. It's easily understandable why they are obscuring that fact and I suppose we should just be thankful that they haven't spread any outright lies on that page, again by explicitly making no claims about herd immunity. Note that the page does explain to people that they need to keep social distancing after receiving the vaccine, which shows that the CDC does acknowledge privately that the vaccine does not prevent transmission of the virus.
But I haven't seen anything that was written in a way that would convince a mildly skeptical human (and I've spent some time behind a micropipette) that vaccines do nothing to prevent contracting and spreading viruses in a meaningful (clinical - not analytical) sense.
I'm coming to this with an open mind, and I don't think I'm being a jerk about anything. I shared a quote from the CDC at face-value. You're just some faceless dude on the internet. Why should I believe you over the CDC?
"At the end of the process, our bodies have learned how to protect against future infection." <-- This is straight-up saying that the vaccine protects you from getting infected. I'm not quoting out of context or anything. If enough people are protected against getting infected, we reach herd immunity. Am I missing something here?
I promise I'm not masterminding some elaborate FUD campaign to undermine your premise. You're just saying something that's super-counterintuitive and then getting angry at me because I don't see clear evidence for it in what you presented.
https://news.yahoo.com/exclusive-vaccine-wont-free-self-1656...
“Although the vaccine will give recipients immunity from the virus, scientists do not yet know whether it will stop them being carriers.
Government sources said it was likely to be months before there was any prospect of the vaccine negating the need for self-isolation.”
What you acqq are posting is “Although the vaccine will give recipients immunity from the virus, scientists do not yet know whether it will stop them being carriers."
Can you see the very fine semantic line that is being walked here?
The public is being told by health officials that the virus gives 'immunity' from the virus. In the same breath, you are supporting the argument that it does nothing to prevent people from contracting and spreading the virus.
You guys are acting like this is all rather obvious, but it's not at all.
If I walked up to someone on the street and said that a vaccine will give them immunity, what do you think they would take that to mean?
Well, the NHS, and the CDC are both saying that the vaccine gives 'immunity' and 'protection.'
You have to stop getting angry at me, and consider that if you're not making a convincing argument to me, how the hell are you going to make a convincing argument to somebody who doesn't have a degree in biochemistry.
“Pfizer chairman Albert Bourla told Dateline host Lester Holt that the pharmaceutical company was “not certain” if the vaccine prevented the coronavirus from being transmitted, saying, “This is something that needs to be examined.””
December 03, 2020 - 02:36 PM EST
Remember the claims at the start of this thread were:
"They [vaccines] do not—and are not meant to—prevent people from contracting and spreading the virus. They only reduce the symptoms."
Albert isn't saying any of that stuff, so why on earth would I disagree with him?
Article goes on to say "In November, Pfizer announced that its vaccine candidate had been shown to be more than 90 percent effective at preventing COVID-19"
Aaaaaand so we're back at my comment before this one. What do they mean by 'prevent?' Because they're saying it 'prevents' COVID-19, just like the CDC did in the quote I shared that svrb got so angry at me about.
You guys are saying the vaccine does nothing to prevent people from getting SARS-CoV-2, but the CDC, and the articles you yourself are sending me are saying that the damn thing 'prevents' COVID-19, which is an infection with SARS-CoV-2.
Is the vaccine magically making people asymptomatic while an infection rages inside of them? Is it preventing a virus that destroys lung tissue from somehow showing any outward signs of dyspnea? Is it somehow blocking a cytokine storm? I don't think so, that's how Dexamethosone is being used to treat this, not vaccines. Maybe in the long run by shifting Th1/Th2 response or something, but that would have quickly become apparent in the routine labs done in the process of clinical trials. Does it magically break up thromboemboli in the bloodstream? How would a vaccine prevent kidney damage from showing up in someone with a raging, yet completely asymptomatic infection?
What is the mechanism by which a vaccine would allow a raging infection to occur inside of someone, while showing zero outward signs of it? Because if it's knocking down levels of active virus in the body by triggering a robust T and B-cell response, it's reducing viral shedding, and it's reducing transmission. That's the same thing that all the papers you have shared with me so far have indicated.
What do you want me to say?
Don't sneeze on grandma until she gets vaccinated. I said that earlier.
Again, regarding CT values, continuity of positive nasal swab PCR results can be totally divorced from significantly decreased lower-respiratory-tract viral titers, as the Nature monkey paper you sent me pointed out.
I ask you again: What is the mechanism by which a vaccine takes a person who would normally be symptomatic, and magically makes them asymptomatic, while having zero impact on titers of virus in the body?
I'm not talking about behavior here. I'm talking about direct, biochemical mechanisms inside of the human body.
The vaccine is reducing viral titers. And by reducing viral titers, it is reducing shedding into the lower airway. And by reducing shedding into the lower airway, it is reducing the number of viral particles contained in respiratory droplets expelled from the airway. And by reducing the number of viral particles that exit that airway, it is reducing transmission as it is intended.
Behavior is a separate discussion entirely, but consider the mechanism I have described. It is not only reducing viral titers in those who would normally be symptomatic, it is also reducing viral titers in those who would normally be asymptomatic. Those silent carriers that are walking around among us, well, now they're walking around spreading a hell of a lot less virus. And that is a big deal, especially in places like Oklahoma, Idaho, Arizona, South Dakota, Wyoming, Florida, Tennessee, Georgia, South Carolina, etc, which as I mentioned earlier, have zero state-level requirement for anyone to wear a mask at all.
You are claiming [or at least not refuting svrb's argument] that vaccines have no impact on titers of virus in the body, and yet somehow they magically render people asymptomatic by a mechanism as-yet unknown to biology.
That's just not how it works. And the fact that vaccines knock down the amount of virus being spread around is a big deal, especially in places where there are no mask requirements in place.
Earlier you accused me of spreading false information, and asked me to apologize for spreading beliefs that can put people in danger, but have you come to see that this discussion is not as clear-cut and binary as you originally made it seem?
I promise I'm not the enemy.
https://www.thelancet.com/journals/lanmic/article/PIIS2666-5...
Your reasoning therefore completely doesn't match the results of many different studies across the world, and also doesn't fit with which people are considered infectious in practice, with all the millions of people involved.
So, the study that I've quoted earlier, which detected high viral load in the upper respiratory tract of non-human primate animal model therefore suggests exactly what I've already mentioned that it suggests, namely, that we can not assume that vaccine provides sterilizing immunity unless the later studies with humans show otherwise. And that is exactly how the UK is going to proceed with their vaccination policy, as I've already documented, and also matches the statement of Pfizer's CEO.
(I also note that you again try to insinuate that my claims are something that I've never even mentioned, hoping to change the topic. Please don't.)
You're saying:
> "all the studies of infectiousness of SARS-CoV-2, and even of other respiratory viruses correlate with detection of high virus load in the upper respiratory tract"
But, RNA fragments detected by PCR in nasal swabs != live, infectious virus.
The paper you linked is saying, instead:
"Our study shows that despite evidence of prolonged SARS-CoV-2 RNA shedding in respiratory and stool samples, viable virus appears to be short-lived. Therefore, RNA detection cannot be used to infer infectiousness."
"Our findings suggest that, although patients with SARS-CoV-2 infection might have prolonged RNA shedding of up to 83 days in upper respiratory tract infection, no live virus was isolated from culture beyond day 9 of symptoms despite persistently high viral RNA loads."
Residual RNA from lysed cells is sticking around and getting picked up on nasal swabs even when actual, infectious, titers of virus in the body are plummeting, and patients are no longer infectious. I used to work with RNA in a research lab! The shit is everywhere. Our experiments used to get contaminated with RNA from the lab next door all the time. I used to have to spray my bench with a bleach solution every day, sanitize my pipettes, and work at night so my RT-PCR experiments didn't get contaminated. That's in the air. Imagine how long it hangs out in the moist, snotty environment of the nasal cavity.
"Nevertheless, most studies demonstrate faster viral clearance among asymptomatic individuals than those who are symptomatic."
"This finding is in keeping with viral kinetics observed with other respiratory viruses such as influenza and MERS-CoV, in which people with asymptomatic infection have a shorter duration of viral shedding than symptomatic individuals."
Giving these people a vaccine will help them clear the infection even faster, which will help reduce community transmission, especially in places where they're now wandering around without masks on, in full compliance with state law.
I'm happy that the UK is prepared to make aggressive and forward-thinking health policy. Good for the UK, but this ain't the UK. There are a lot of countries like the US where I live, as well as my neighbor Mexico that don't have an NHS, and don't live on a small island with a well-functioning government. These vaccines will help to reduce community transmission in places where the scenes from urban hospitals can best be described as nightmarish.
"No part of the world has been as devastated by the pandemic as Latin America. Mexico, Brazil, Peru and other Latin American countries — hobbled by weak health systems, severe inequality and government indifference — have several of the highest deaths per capita from the virus in the world.
And unlike in Europe, the United States and many other regions, the outbreak in Latin American has not struck in waves. It hit furiously in the spring and has continued for months, with few of the respites savored elsewhere, however briefly, around the world. By the first week of September, the 10 countries with the highest deaths per capita were all in Latin America or the Caribbean."
https://www.nytimes.com/2020/09/23/world/americas/mexico-cor...
Again, shift your frame of reference. The rest of the world does not look like the UK and Europe. Enjoy living somewhere that isn't a charnel house. The vaccines reduce community transmission, and I can say that confidently because I have outlined a pretty clear mechanism for it and there is zero data you ...
I show you the findings about upper respiratory tract, you then cite "respiratory and stool samples" sentence from the paper as if it somehow disproves what is supported by the paper and the ones it references, that the high viral load in the upper respiratory tract before symptoms and during the first days of symptoms is critical.
You cherry pick the sentence about the "viable virus" not being present "beyond day 9 of symptoms" (meaning day > 9) but that doesn't disprove what is claimed in the studies: that the transmission occurs even before symptoms (days -2 -1 and 0) and during the first few days of symptoms, that is, before the host's immune system has the time to fight the virus infection.
https://academic.oup.com/view-large/figure/210823252/ciaa144...
from
https://doi.org/10.1093/cid/ciaa1442
The scientific facts aren't less true in the US than in the UK and Europe. Your claim that you "used bleach solution" in the lab also doesn't make your wrong theory and your other wrong claims less wrong. Of course PCR tests detect RNA longer than the infectious virus is present, but all studies I've cited haven't ignored that fact.
I pulled and quoted specific sentences so you didn't have to dig through the paper to see what I'm talking about.
If I'm wrong, and the paper clearly says how I'm wrong, pull the specific sentences and show me. Then I don't have to dig through a research paper trying to guess what you're seeing in there that makes you think I'm wrong. I've outlined a specific mechanism, you can pull things from the papers and refute my mechanism line-by-line if you want. I'm not being vague about anything. I'm spelling it out pretty clearly. If I'm wrong, show me how I'm wrong and then I and everyone reading this will be able to see clearly how I'm wrong.
> "I show you the findings about upper respiratory tract, you then cite "respiratory and stool samples" sentence from the paper as if it somehow disproves what is supported by the paper and the ones it references, that the high viral load in the upper respiratory tract before symptoms and during the first days of symptoms is critical."
I haven't seen any other method of measuring viral load in the upper respiratory tract than PCR. Maybe I've missed something? But in the lower airway they're using lavage in live animals and tissue immunohistochemistry in sacrificed animals to determine actual viral load. So, we don't actually know viral load in the upper respiratory tract from nasal swab PCR specimens (since, as they mentioned in the last paper, PCR from nasal swab doesn't actually correlate with viral load). Do you know of a way that they're measuring upper respiratory tract viral load other than nasal swab PCR?
The point of the bleach anecdote is to highlight what this paper said, which is that you can't estimate viral load based on nasal swab PCR since very high levels of mRNA hang out in the snout for long past the time when infectious viral titers have diminished.
So we came to the truth: you didn't try to read how the researchers perform their research, even if they do publish their methods in the few papers you argue against, but you still claim here you know more than they do.
Of course the researchers can and do establish in their papers how much there's infectious virus in the upper tract. It's just a practical trade-off that, on the mass scale of all the millions of tests daily for clinical purposes, only PCR tests are preformed.
I've given you a single meta-analysis paper instead of linking to all the papers that paper refers to. Whichever detail you'd like to know, the paper links to them. It's mostly a click away. Almost all papers are also open access, meaning that you can read them in full. Moreover, for even those which aren't open access, typically the "appendices" are open access, exactly the parts that describe the methods used in the paper.
So, yes, we do know the actual viral loads of infectious virus good enough (1) to conclude what I wrote. And the conclusions, dumbed down enough, are what I've written before and eventually they can, when we're lucky, even end in the policies in the UK and statements of Pfizer CEO: there's enough research right now to not assume sterilizing immunity, unless the future studies show something else. That's science, it's seldom 100% certainty in 100% of effect.
You can either write about bleach all day or you can try searching in the paper and the references for what you want to know if you really want to learn something. Fishing for single sentences out of the context that support your wrong theories while claiming you know more than the majority of researchers is dishonest and contra-productive, unless you really just want to waste time of everybody (there are actually people paid to do that too, unfortunately).
---
1) Even for a single patient the actual existence of infectious virus can be established and the paper published: https://www.cell.com/cell/fulltext/S0092-8674(20)31456-2 "(SARS-CoV-2) shedding was observed from the upper respiratory tract of a female immunocompromised individual" ... "Shedding of infectious SARS-CoV-2 was observed up to 70 days" Yes, "upper respiratory tract" and "infectious SARS-CoV-2."
I just read the paper you cited there. They're not determining titers of infectious virus in the upper respiratory tract with any other method than PCR. So, yeah, I'm right. I had just assumed you had read the papers and seen something I missed. You're making me second-guess myself, but I'm doing a pretty good job of cruising through these papers and understanding what they're actually doing.
Again, from the other paper you sent me, "RNA detection cannot be used to infer infectiousness."
The Pfizer CEO, Albert Bourla is a 'business executive and veterinarian."
Uğur Şahin MD, chief executive of Germany’s BioNTech, and whose main fields of research are cancer and immunology, and whose company actually developed the underlying technology of the mRNA vaccine jointly released with Pfizer had this to say:
'"I'm very confident that transmission between people will be reduced by such a highly effective vaccine - maybe not 90% but maybe 50% - but we should not forget that even that could result in a dramatic reduction of the pandemic spread," he said.'
https://www.bbc.com/news/health-54949799
No sterilizing immunity required.
I'm measuring my interpretation relative to actual scientists. Not just a random CEO who held a press conference. Albert, although he probably doesn't have as deep an understanding of the biology as Uğur, probably knows a hell of a lot more about manufacturing processes, and global distribution networks.
Imagine reducing asymptomatic transmission by 50%! That's insane. That's so awesome! It's going to cut transmission of this virus in half, even by a conservative estimate.
If I was able to sit down with Uğur, (who obviously has a much deeper understanding of the mechanism of action than I do) I'm willing to bet that his mechanism isn't so different than mine. Sounds like he and I agree on a lot!
It's no use for me even trying to discuss with you when your "reading" ends with recognizing that some paper mentions "PCR" and then claiming you're right in general, and all the epidemiologists and virologists aren't.
Anyway, AstraZeneca study just came out, and apparently even when the vaccine efficacy was 90%, the number of asymptomatic cases in the group where that was also measured dropped only 27% percent, which suggest again that the societies can't depend on vaccine providing sterilizing immunity -- it still appears that the vaccinated will be able to transmit the virus, just like the materials that I've referred to suggested.
That's why the UK starts with vaccinating first the most vulnerable, they know it's about protecting from illness, not about making the vaccinated impossible to transmit, as it's covered in many news in the UK -- the expectation is that, at the end, the immunity of population will only be reached once everybody is vaccinated. You can claim that nobody but you gets it, and that your "theory" is better than what's observed in many papers, but it's also a certain symptom.
They may be confirming virus is present with other technologies, but the only way they're measuring viral titer is with PCR.
I don't claim that nobody but me gets it. The head of BioNTech seems to be saying exactly what I'm saying. I don't claim to say anything different from him.
Let's both come together to draft a public health statement that we both would feel comfortable releasing to the public. I'll go first:
Although new vaccine technologies will (1) aid in preventing members of the public from becoming severely ill with COVID-19, (2) will help significantly reduce the number of people contracting the virus in a clinically meaningful sense, and (3) will help to significantly reduce transmission in a community setting, it will be important for members of the public to continue wearing masks and maintaining social distancing until such a significant portion of the population is vaccinated that infection rates as-measured by nasal-swab PCR begin to show significant decreases, and ICU capacity is restored. Based on this, we will incrementally re-open and relax restrictions as deemed appropriate.
Sound ok to you?
1) can I or somebody else transmit the virus to somebody I care about and cause them to end on the ICU or die and
2) I know that no country actually measures "infection rates" with PCR but uses that only as a tool to count the "confirmed cases", where a lot of "confirmed cases" are anyway in bad enough state to need hospitalization (meaning it's expected the will need at least something like oxygenation in hospital, if not intubation in the ICU). I also know that there are cases where the CT scan directly shows that somebody is a "case" even if the repeated PCR is negative. So I don't worry too much about the PCR alone, it's just one of the tools.
I also know that some of those who come in contact with the vulnerable which I know will very probably get the vaccine much earlier then I will. I know they will have to behave like they aren't vaccinated, and I know it will be hard for them to accept that, like it was for you to even agree it's a real problem.
I also know that I personally will have to be potentially careful not to think that I can't transmit to somebody who is in worse shape than me, even once I am vaccinated. I know that even if the vaccine has 95% efficacy, it doesn't mean that somebody I care about isn't in the remaining 5%. I also won't know if I am not in the remaining 5% and pre-symptomatic exactly in that moment. And like I've written, it can be it's even worse, and we have to assume that until the studies show otherwise.
And on the higher level, I have to care about everybody actually: as long as the disease spreads, everybody is worse off. The sooner the broad measures don't have to restrict any activity, the better for everybody. I want the real "recovery" as soon as possible.
So what will I do?
a) follow the results of the ongoing studies hoping for some better news, but not assuming everything simply has to be perfect.
b) prepare myself and those I want to remain in contact with that we'll have to be as careful as we are now until there's simply much less prevalence. If I were in Australia now I'd allow myself much more than I will do for some months here where the prevalence (number of people who are new cases every day) is what it is (and it's similar in a big part of the Western world). So I expect that it will be quite hard for everybody for more coming months.
c) try to make as much people as possible understand that the vaccine is almost surely (even with 95% efficacy it's 1 of 20 for whom it's not "working") not something giving them any new "powers." The more are aware of that, there's bigger chance that the prevalence will go down earlier, and that will protect everybody sooner. And it will save some lives, maybe exactly those I know.
In short, it will be very obvious that it's significantly "better" once when the prevalence goes down to something like Australia (7 new cases today among 25 million people, hey! But it's Summer there) and people I care about (including me) are vaccinated. And that "better" won't start at the moment anybody particular has received the vaccine while the prevalence is still much higher. Vaccine simply won't be a magical shield for any single person, as long as the prevalence isn't low. Which is why always more experts now also say that we should do vaccine trials for the children and if needed start vaccinating them too from some point on (once the trials confirm it's safe and the prevalence still exists). I know people who will surely try to be in close contact with their grandchildren before the risk for them is actually low enough.
We will also have to be careful to observe the prevalence in context of how much measures ...
Good chat.
Thank you for the conversation.
While Mr. Bourla is a 'business executive and veterinarian', another member of the Pfizer/BioNTech team has a different perspective.
Uğur Şahin MD, chief executive of Germany’s BioNTech, whose main field of research is cancer research and immunology, and whose company actually developed the underlying technology of the mRNA vaccine jointly released with Pfizer had this to say:
'“I’m very confident that transmission between people will be reduced by such a highly effective vaccine — maybe not 90% but maybe 50%,” he said.'
https://apnews.com/article/europe-coronavirus-pandemic-1e199...
He is wwwaaaayyyyy more qualified to have insight into the efficacy of the vaccine than a CEO and vet who has never done research in or treated human patients in the field of immunology.
Ah fuck it; nuking my account. I shouldn't waste time here arguing with people.
It's like going to the gym, but it prepares you to have face-to-face discussions with real-world people whose opinions you actually care about, rather than strangers on the internet.
I've been downvoted, and disagreed with many times, but I can't say I didn't learn something new each time, even if it was about something as basic as the way I phrase comments.
Cheer up, maybe you were completely right, and other people just didn't quite get what you were saying!
- Racial bias in medical research is real and methods for increasing fairness are urgently needed in clinical trials
- We don't know for sure how racial bias was balanced on most phase 3 trials, because most research protocols were not disclosed to the science community
- Since efficacy was measured by the sub population in the phase 3 trials who got infected, we can perhaps have other confounding factors who can affect more, or less, some ethnicities (for example, someone can raise the hypothesis that some cultures are more prone to use masks and keep distancing, reducing inherent risks, and that can be true)
- Sample sizes for the phase 3 studies so far very small (perhaps enough to assess minimal efficacy?) for ANY race/ethnicity. We hope that with the increase of the vaccinated population we can have a more precise estimate
- We are talking about 95% inside a confidence interval which is still uncertain lower/higher boundaries, given the small sample
- It is very dangerous to claim any statistical conclusion with small sample sizes
- Almost all "advanced machine learning AI methods" fail miserably. And they fail even worse with small datasets (which is the case). Examples are the handful of "covid pollsters" we got since the beginning of 2020, trying to guess how many people would die, or get infected.
- About vaccine efficacy in asians - we should monitor phase 3 results of CoronaVac (the chinese vaccine) trials (which are in course in China, Brazil and other countries), so we can account for these biases. I heard these results are coming in the next few weeks
If a large enough majority of the population become immune that we achieve herd immunity, that will still protect the minority of people for whom the vaccine didn't work.
https://www.medscape.com/viewarticle/941030?src=soc_tw_20111...
"In an ideal world, a vaccine would prevent infection entirely and, it follows, also prevent disease and severe disease. But this may be hard to achieve for a respiratory virus vaccine. Animal challenge data suggest that vaccinated animals may still be infected even if they don't experience symptoms. A vaccine that is able to reduce the severity of disease, even if it cannot prevent infection entirely, would obviously still have enormous public health value. Therefore, this is what trials target as their primary aim."
Not all vaccines are the same.
For mumps, totally different kind of disease, to prevent an outbreak, there was a following calculation:
https://vector.childrenshospital.org/2017/03/social-media-mu...
"since one in 10 vaccinated people are still susceptible to mumps, an overall vaccination rate of 96 percent is needed to prevent an outbreak"
For Covid-19, to note from the first source again:
"A vaccine that is able to reduce the severity of disease, even if it cannot prevent infection entirely, would obviously still have enormous public health value. Therefore, this is what trials target as their primary aim."
But it's reasonable to also expect the following to be shown when there's more time:
* The milder infection makes such infections less transmissible (in terms of duration-of-infectiousness of quantity-of-sheddding)
* such superficial infections in the vaccinated don't recur often, or as they recur become ever-milder – because the nasal/mucosal surfaces themselves eventually improve their immunity. So, an extra step is required to achieve the simplified idea of 'herd immunity', but the vaccines is still one step in that direction.
So it is still very much the hope & eventual aim of these vaccines to keep enough people alive, with mild easily-recovered infections, that 'herd immunity' (and thus much-lower or almost non-existent rates of infection even in the unvaccinated) is reached.
Neither reduced duration of infectiousness nor reduced quantity of shedding by definition protects the vulnerable.
It can reduce the speed of spread, but that by definition doesn't even mean that a vaccinated person can visit their non-vaccinated or immune suppressed relative without the mask.
For all we know the "quantity of shedding" has to be very low for transmission to provably not occur -- some experts estimate that a single droplet containing only 500 viruses is enough. To compare, the typical tests measure the presence of virus RNA starting with many millions in the sample and the tests do detect asymptomatic persons -- those who don't get sick now.
> superficial infections in the vaccinated don't recur often
From the studies of other coronaviruses it is known that infections do recur.
And finally, we even know that even some percentage of people who get the vaccine become the disease later and are observably sick -- that's the difference to 100 to efficacy percentage (e.g. 5 of 100 who received the vaccine, or every 20th, if the efficacy is 95%).
And we can also expect effectiveness (protection of the vaccine in the real world) to be lower than efficacy (reported from trials).
In short, for all we know at the moment, the life will continue to be hard for those who don't get the vaccine and those whose immune system can't respond to the vaccine.
Everything which reduces community prevalence (& case replication rates) protects the vulnerable, at least indirectly.
Briefer and lesser shedding of infectious material is also likely to also contribute to milder cases among the unvaccinated - so they acquire natural-recovered immunity, both surface-mucosal and deep, over time with fewer risks to themselves & others.
You are correct that simply having recently completed an initial vaccination should not give anyone confidence to immediately visit a vulnerable, unvaccinated person. After all, a surface/mucosal/sub-symptomatic infection that's still transmissible remains a possibility, especially while community infection rates are high.
But 6-12 months later, when infection rates are low, and it's quite possible the vaccinated person has already been mucosally-challenged by naturally-circulating virus? At that point, the net effect of vaccines-over-time means the risk of such visits to the non-immune likely returns to the same baseline level that they had in 2018 and before, from everpresent pneumonia/flu concerns.
> And we can also expect effectiveness (protection of the vaccine in the real world) to be lower than efficacy (reported from trials).
It could go either way. Even in trials attempting blinding, often the vaccinated have a strong hunch (from side effects) they've received the active vaccine - and so take more risks than the placebo arm, thus causing the trial to underestimate actual protectiveness.
Also, to the extent early vaccinations could be well-allocated to either most-vulnerable or most-likely-to-spread – subgroups that weren't overweighted in the trials – they could show more effectiveness in disease-prevention.
And this only improves as herd immunity grows: in a tiny trial, others' vaccinations have little indirect protective effect, but as immunity rates rise in the community, there's a compounding benefit.
You can't have T-cells and antibodies covering every single potential surface area of every cell of every tissue in the body, so there can be places that are infected in the body even though you're totally subclinical and not shedding in a meaningful sense. But such a small infection that is effectively managed by a vaccine-primed immune system is meaningless. That's like saying that a clean living-room floor isn't really clean because you can spot a speck of dust with your magnifying glass.
For all intents and purposes, vaccines prevent people from contracting an infection that is clinically meaningful, and that can be spread to others in a way that leads to infection. That's herd immunity.
"Herd immunity is a form of indirect protection from infectious disease that occurs when a sufficient percentage of a population has become immune to an infection, whether through vaccination or previous infections, thereby reducing the likelihood of infection for individuals who lack immunity."
https://en.wikipedia.org/wiki/Herd_immunity
You're making it sound like vaccinated people are walking around shedding virus all over the place, but simply showing no outward signs.
That is exactly the mechanism how non-sterilizing protection by vaccines for respiratory diseases occurs: the cells in mucosa in the upper respiratory tract are infected every time one is exposed to the virus before the antibodies can respond. The mucosal cells shed the virus even if the infection doesn't have to result in symptoms. The viral shedding is however high enough to allow transmission to the unprotected.
Note that at this very moment there are still no reports of a vaccine inducing sterilizing immunity, especially in nasal mucosa.
Up to now, for the vaccines which reported the efficacy, it was by design measured and reported as protection to the symptoms of the disease. The press releases take care to mention "efficacy according to the primary study objective", where just "protection from Covid-19" (as in: from the disease with defined symptoms) was reported. Not the sterilizing immunity. (2)
And, specifically for Covid-19:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
"Challenge studies in vaccinated primates showed reductions in pathology, symptoms, and viral load in the lower respiratory tract but failed to elicit sterilising immunity in the upper airways." (1)
"These observations suggest that we cannot assume COVID-19 vaccines, even if shown to be effective in reducing severity of disease, will reduce virus transmission to a comparable degree. The notion that COVID-19-vaccine-induced population immunity will allow a return to pre-COVID-19 “normalcy” might be based on illusory assumptions."
"Crucially, it will be important to communicate to policy makers and the general public that first-generation vaccines are only one tool in the overall public health response to COVID-19 and unlikely to be the ultimate solution that many expect."
(Note: All cited here are the papers directly studying Covid-19, which are far more relevant in this case than a wikipedia article about what "herd immunity" were, when and if it exists.)
1) See https://www.nejm.org/doi/10.1056/NEJMoa2024671 and Figure 3 and https://www.nature.com/articles/s41586-020-2608-y "Viral gRNA was detected in nose swabs from all animals and no difference was found on any day between vaccinated and control animals."
2) See also my other posts here, e.g. the one which directly cites the Moderna protocol. https://news.ycombinator.com/item?id=25286838
Also, regarding the nasal swabs in those monkeys in the nature paper, you're not spraying respiratory droplets all over the place out of your nose when you vocalize. It's coming out of your trachea and oropharynx as those vocal cords vibrate and air gets pushed out of the lower airway. You don't sneeze at the grocery store cashier whether you want paper or plastic.
"We observed a significantly reduced viral load in the bronchoalveolar lavage fluid and lower respiratory tract tissue of vaccinated rhesus macaques that were challenged with SARS-CoV-2 compared with control animals"
That's a HUGE win in reducing transmission.
Come on, you gotta be a little more enthusiastic here! These vaccines getting out there are going to have a MASSIVE impact on knocking down this pandemic.
What we still can't expect, until we have some different and exact information, is to be able to visit our non-vaccinated or immune suppressed relatives and friends without a mask and be really sure that we can't infect them as long as the incidence is high enough. What we currently know says the opposite: no proof of sterilizing immunity by the current vaccines, and animal studies which show the same viral load in upper respiratory tract mucosa.
That's what I personally worry about, I have such people and I don't want them to die because of the, at the moment still unfounded, belief of some (like "phobosanomaly" who uses totally irrelevant quotations to support their claims) that the vaccine must have "sterilizing immunity" while the experts are cautions to point that the currently available information surely doesn't support that.
And if "phobosanomaly" now also doesn't claim at the moment that the vaccines have such property but merely that the transmission will be "reduced" then I don't disagree with that. But for me "transmission will be reduced" as this moment still means "we can't even assume that the vulnerable can't become infected from those who already received the vaccine."
Also note that the distribution of those who get the vaccine but then still become ill (1 of 20 by Pfizer and Moderna trials) will also not be evenly distributed across the population. That means that if you know even less vulnerable people, you can expect that some of them won't be protected even if they can and do receive the vaccine. I worry also for those.
If you also maybe believe that the vulnerable are disposable because they are old and not productive anymore or something like that, I can assure you that I personally know young and worthy people who can still contribute a lot to the world but who can surely be considered vulnerable, and who surely aren't doing anything wrong, who aren't overweight and who are doing sports regularly.
And finally, I admit I also worry for those who I know who are considered "older" but whose number of days on this planet can also be seriously affected by the attitudes of those who want to believe only that what is convenient to them, even if it is completely opposite of what is currently known.
I assure you that your immunocompromised friends and family will benefit significantly from getting people vaccinated, in the same way that they currently benefit from vaccination campaigns surrounding seasonal influenza. Not only that, I'm sure your severely immunocompromised friends and family will appreciate actually being able to get their hands on N95s again.
If your friends and family are that immunocompromised, you should be wearing a mask around them anyway, because they're very vulnerable to a hell of a lot more bugs that you could be toting around than just SARS-Cov-2 .
But, understand that if you live in the United States, there are thousands and thousands of people dying every day from a raging, uncontrolled pandemic that a significant percentage of the population has chosen to simply ignore. I am not the enemy here man. If you think the enemy is someone on HackerNews who actually takes the time to read the papers you cite, you need to take a trip to an Oklahoma WalMart.
Remember, I'm not the guy you need to convince to be cautious. I'm the guy advocating the public health benefits of vaccination, not the guy running around telling people that masks are for pussies and that vaccines will give you autism. You have to have a sense of perspective about this whole thing.
These vaccines are awesome. They are literally a wonder of modern biotechnology. This technology is pretty much completely novel! This is a net plus for the entire human species.
Your claim "you should be wearing a mask around them anyway, because they're very vulnerable to a hell of a lot more bugs that you could be toting around than just SARS-Cov-2" is also wrong. It's also provable, and was easy to read in the press for months, that many people who would otherwise live decades longer, without people around them wearing masks, already died form SARS-Cov-2. There are still many such who have tried to protect themselves in these months but who will be more exposed to those who would wrongly believe in "sterilizing immunity" of the vaccine if there is no such.
So it's important to be scientifically accurate. At the current moment, all we know is that the vaccines protect the vaccinated from getting sick. We still don't know that the vaccinated can't transmit the virus to the vulnerable, and until we know that, we must say that we don't know that and protect the vulnerable!
As Lawrence Rifkin MD writes, also at the moment on HN: https://news.ycombinator.com/item?id=25287076
"So when facing loss of innocent life in a house fire, cry openly. Allow yourself to hurt deeply. Comfort the bereaved. But don’t say “it was meant to be” or “they’re in a better place.” Go out and promote stoves with smoke-sensing, automatic shut-off valves. The fact that we have the ability, through conscious choice and action, to change the world and make it a better place is a fundamental wonder of being human. It’s what being good is. Not for the benefit of some other world, but for this, our one world; not for some supernatural being, but for our fellow beings."
I don't think you're drawing a distinction between pathologically immunocompromised individuals, and individuals who may not have as robust an immune response as others, but who can receive a vaccine. In someone who is pathologically immunocompromised, you should 100% be wearing a mask around them normally. They are not safe if you do not because they are vulnerable to a wide number of pathogens. If they are simply elderly or at-risk, let's get them vaccinated!
My mom is elderly and very vulnerable, but she is not pathologically immunocompromised. She has a reaction to flu vaccines. I will most definitely be recommending to her that she receive either the Pfizer or the Moderna vaccine. There may be an adverse reaction, but she'll be a hell of a lot safer than if she didn't receive the vaccine and catches COVID. At some point people will stop wearing masks in the community (Neither you nor I have any control over this), and she will have to decide for herself if she chooses to enter the community unmasked, or if she will wear an N95 for the rest of her life.
And, as I mentioned earlier, at the end of the day, what will happen will happen. Do you think the United States will go into a full China-style lockdown at some point to protect people who are unvaccinated after the vaccine has reached wide distribution? It's not gonna happen! It doesn't matter how either of us feels about this. It's just not gonna happen. The best plan we have for moving forward is to get as many people as we possibly can vaccinated. Based on my understanding of immunological mechanisms I believe that it is highly likely this will reduce community-transmission (you haven't convinced me to let go of my suspicion based on the evidence presented, and I think the monkey paper in fact strengthens my argument). For those that refuse to be vaccinated, or that are pathologically immunocompromised, their best bet will be increased access to N95 masks to actually filter incoming air, and the fact that they will once again have increased access to the healthcare system that they do not now have.
What is your alternate proposal? Do you think the US will lock-down and mandate masks for the next 10 years, even after widespread vaccine distribution? Remember, we are not talking about science here, we are talking about policy. And despite Dr. Rifkin's faith in the angels of our better nature, and that "Our non-rational sides should inspire and inform reality, not dictate our perception of it," again, I invite you both to visit an Oklahoma WalMart and confront the fact that policy does not follow these humanitarian ideals. To quote from Ben Rhodes' memoir, "We take the world as it is, not as we wish it to be."
https://news.yahoo.com/exclusive-vaccine-wont-free-self-1656...
As you ask what my proposal is:
1) You should apologize for spreading the beliefs that can put people in danger and stop doing that.
2) Understand what's currently scientifically known, and avoid spreading misinformation.
3) Regarding what the policy should be: allow the science to do its work instead promoting measures or beliefs that can put people in danger. The world had enough of that for months. Vaccines are good and should be used, but not believing what you promoted -- not behaving as the immunity provided by the vaccine was higher than what's known at the moment.
Don't worry. Nobody else is reading this thread at this point. It's you, me, and svrb. You can relax. I'm not a clinician or an epidemiologist, and based on your arguments I don't think you are either, so the stakes are low. We're just having fun debating on the internet.
I'll put in a disclaimer if it will help you sleep better at night: "At no point in this obscure thread in the dark corners of HackerNews does phobosanomaly advocate that within 10 months of receiving a SARS-CoV-2 vaccine should you be coughing on your elderly and comorbid friends and family who have not received a vaccine. Instead, you should bug them to get vaccinated as soon as possible!"
Having a scientific hypothesis isn't a license to do stupid shit. I assumed I didn't have to spell that out.
With regards to this: "Now the whole country is warned as explicitly as possible." I guess you're in the UK. I live in the USA, and it's a whole different ballgame over here. I don't think you quite understand my Oklahoma WalMart comment. There are people in Oklahoma WalMarts who refuse to wear a mask, and who open-carry handguns in case anyone tries to force them to. That is perfectly legal in this country, and very common depending on where you are. I think we're arguing from a totally different frame of reference when considering matters of policy. The United States is in complete free-fall, and there are places here where you can get shot for requiring someone to wear a mask. I am more concerned with triage, than the fine details of what happens once a significant percentage of the population is vaccinated. You must understand just how bad it is here.
That's why I was astonished about how passionate you are about the fine details of this. We do not have a vaccine here. 3,000 people are dying every day. We have lost 276,000 people already. ICUs are at capacity. There are entire swaths of the population who do not believe the virus is real. We have no NHS. There is no vaccine distribution network. There is no plan. There is no-one in charge. Our president is currently occupied with trying to overturn our last presidential election. Mask compliance in massive parts of this country is a pipedream, so to be concerned about whether there will be mask compliance after widespread vaccine distribution seems utterly absurd. We're hoping we can actually get a vaccine distributed in the first place, and still trying to get people to wear masks to begin with. I need you to understand that in the entire state of Oklahoma, there is no requirement to wear masks at all, and the governor has instead proposed that the state have a day of prayer as a solution.
Shift your frame of reference. I am not the enemy. You haven't the foggiest clue of the degree to which I am not the enemy.
2)
I get what is currently known. There is no definitive randomized clinical trial that clearly demonstrates that a person vaccinated with the Moderna or Pfizer vaccine can in no conceivable situation spread virus to others. The public health officials you quote are saying just that. I don't dispute that at all.
However, the absence of a specific randomized control trial does not mean that I cannot strongly suspect that, as I put it, "it is highly likely that it [the vaccine] knocks down viral shedding significantly." There's a clear mechanism for that, and papers you cited pointed that out. In those monkeys, the vaccine significantly knocked down viral shedding in the lower airway. It seems pretty darn plausible to me.
Are you familiar with the famous parachute study?
"Parachute use did not significantly reduce death or major injury (0% for parachute v 0% for control; P>0.9). This finding was consistent across multiple subgroups. Compared with individuals screened but not enrolled, participants included in the study were on aircraft at significantly lower altitude (mean of 0.6 m for participants v mean of 9...
> Modern scholarship regards race as a social construct, an identity which is assigned based on rules made by society. While partially based on physical similarities within groups, race does not have an inherent physical or biological meaning.
https://en.wikipedia.org/wiki/Race_%28human_categorization%2...
You see the paradox?
But in this context, we're talking about first-order biological effects that aren't accounted for because of race. If race doesn't have biological underpinnings then the larger argument is meaningless.
If indeed the vaccine may be less effective for certain populations then name them and leave the vagaries of race baiting to the tabloids.
There are no races in the human species, due to genetic reasons: the lack of well-delimited genetic clusters (like we see for dogs, cats, cows, horses, etc.) and the large number of inter-group genetic distances that are shorter than intra-group ones.
US geneticists and anthropologists understand all that, but it seems that vast sections of the population are still on board with scientific racism - not very surprising, when official census forms still have separate fields for "race" and "ethnicity".
>Spreading incorrect information about biology is contributing to disinformation and fake news.
Really, it is incredible how a one line comment changed the whole universe of fake news and disinformation.
I can also only assume that you are not the average reader here, but some one with higher knowledge in every aspect of life and Science.
Thanks for you comment. I am starting to clean my social media activity and in the next day or two, I will probably kill myself. Thanks for letting me see this, I cannot live with the drastic contributions I made to spread disinformation online.
As a higher being, can you tell me the easiest way to end my life? I am looking for something not painful, and something that would not traumatize my son, as we live together and I work from home.
Again, thanks to make me see the light. Without you, the world would have to endure another fake news spreader. Be assured that my family will send you part of my life insurance, as soon as we get your name and address.
What is significant is genetic variation tends to be geographically distributed. https://www-nature-com.stanford.idm.oclc.org/articles/ng1435. Making a universally effective vaccine needs to start off with a geographically diverse sample of both the virus and the population to be vaccinated.
I remember a huge uproar: "we are not your guinea pigs". And I totally understand the sentiment. The vaccine will mostly benefit rich white people, while the poor Africans will, as always, get the short end of the stick. And I have no doubt it will happen like that.
But, by refusing trials in your poor country, you basically lower your chances of getting an effective vaccine when it matters from not much to zero. Allowing trials should be a good way to negotiate a way to secure doses for yourself, since you can't do it with money like first world countries. But it is also a way to have the vaccine tested on your population rather than only on white guys.
And sure, there are risks in doing that, but Covid-19 kills in Africa too. I didn't do a risk analysis but I am quite sure it is a net positive for the "guinea pig" countries.
And sure, in an ideal world, we should all work together and treat everyone independent of status and wealth in order to end the global pandemic as quickly as possible. But past events showed us it doesn't work like that. Rich countries fighting to secure resources (tests, masks, vaccines, ...) for themselves. The push for buying domestic products instead of from evil China. The very idea of evil China, partly justified but overblown for patriotic effect... Africa will get nothing but scraps unless they have a bargaining chip, and hosting vaccine trials could have been that chip.
And for what? Most African countries are dealing with COVID perfectly fine. Europe and America are the ones where the suffering is disproportionate to the norm. This is not a case of Africa suffering for its lack of desire to play ball with Western powers; it's one where Western powers killed hundreds of thousands of their own citizens unnecessarily. If there's any injustice, it's in that the people paying the price in our countries are the people who get screwed over by institutional neglect - sometimes, sabotage - time and again.
As well, there's less of a potential PR-hangup for a Chinese company if they have to grease the local wheels with some cash 'donations,' whereas Pfizer and Moderna probably wouldn't want to be caught bribing people in the context of a clinical trial (I used to work for a Chinese immunodiagnostics company that did business in the developing world. It's just how things work some places if you want to enter a market and don't have the right political connections).
It's not Africa-focused particularly, but they're running tons of clinical trials across the developing world, and will give these countries early-access that they would not otherwise have with the Western vaccines.
https://www.sciencemag.org/news/2020/11/global-push-covid-19...
Even assuming their data is correct, the variation in effectiveness is 10% and for people in their worst case scenario group it would still be one of the most effective vaccines every created.
If "effectiveness" is currently being measured as reducing symptoms, could Vitamin D levels be a likely additional factor, known to correlate with ethnicity? Could "low Vit D" plus "no vaccine" be additive toward increased symptoms?
Based on a quick scan of the preprint I see no reference to Vit D.